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SOCIAL  SERVICE  AND 
THE  ART  OF  HEALING 


SOCIAL    SERVICE 

AND  THE 

ART  OF  HEALING 


BY 


RICHARD  C.  CABOT,  M.D. 

Assistant  Professor  of  Medicine  in  the  Harvard  Medical  School 
Assistant  Visiting  Physician  at  the  Massachusetts  General  Hospital 


NEW  YORK 
MOFFAT,  YARD  AND  COMPANY 

1912 


fb'Z1Q,-?-b' 


CopyrigM,  1909,  by 

MOFFAT,  YARD  AND  COMPANY 

New  Yobk 


All  Eights  Eeserved 

Published,   September,  1909 
Reprinted,  December,  1909 
Reprinted,  January,  1912 


THE  QUINN    &.   BODEN    CO.    PRESS 
RAHWAY,    N.    J. 


To  the  Social  Workers  of  the 
Massachusetts  General  Hospital, 
whose  fruitful  labors  this  book 
lamely  but  most  gratefully  describes. 


The  author's  thanks  are  due  to  the  editors  of 
The  Survey  and  of  American  Medicine  for  per- 
mission to  reprint  portions  of  Chapters  II  and  IV. 


INTRODUCTION 

This  book  is  written  to  exemplify  three 
forms  of  team-work  which  are  now  tend- 
ing to  ennoble  medicine. 

1.  Social  service — the  modern  type  of 
what  used  to  be  called  philanthropy — is 
drawing  nearer  and  nearer  to  medicine. 
Public  health  and  the  extermination  of 
disease, — that  most  fruitful  cause  of  pov- 
erty, of  misery,  and  of  crime, — are  the 
ideals  for  which  doctors  and  social  workers 
are  joining  hands  to-day.  When  the  doc- 
tor looks  for  the  root-cause  of  most  of  the 
sickness  that  he  is  called  upon  to  help, 
he  finds  social  conditions,  such  as  vice,  ig- 
norance, overcrowding,  sweatshops,  and 
poverty.  When  the  social  worker  ana- 
lyzes the  reason  why  a  family  is  in  need, 
why  a  bread-winner  is  slack  or  shiftless, 

vii 


viii  INTRODUCTION 

why  girls  go  wrong,  and  boys  are  caught 
stealing,  he  finds  physical  conditions, 
medical  conditions — poor  nutrition,  bad 
air,  alcoholism,  tuberculosis,  injuries  in 
factories — staring  liim  in  the  face. 

Therefore  team-work  of  doctor  and 
social  worker  is  called  for,  and  the  two 
professions  are  beginning  to  hear  this  call, 
to  feel  this  kinship,  and  somewhat  bash- 
fully to  work  together. 

2.  But  moral  and  spiritual  problems 
also  branch  out  of  medical  problems.  Be- 
hind much  phj^sical  suffering  is  the  mental 
torment,  the  doubt,  fear,  worry,  or  re- 
morse that  the  stress  of  life  has  created 
in  most  of  the  sick  and  in  many  who  call 
themselves  well.  Without  recognizing 
and  treating  these  ills  of  the  mind  it  is 
impossible  to  control  the  bodily  sufferings 
for  which  people  consult  the  doctor. 

The  doctor  must  be  a  psychologist,  an 
educator,  a  physician  to  the  whole  man — 
body  and  soul  ahke.    But  can  he? 


INTRODUCTION  ix 

Again  team-work  is  the  need.  The 
doctor  must  work  with  the  educator,  the 
psychologist,  and  the  minister  as  well  as 
with  the  philanthropist.  Only  in  this 
way  can  he  become  liimself  an  educator, 
a  teacher,  putting  the  truth  into  his  pa- 
tients' minds  and  letting  it  do  its  own 
work  there. 

3.  The  problem  of  truth  speaking  vs, 
deception  and  concealment  in  medical 
practice  springs  naturally  out  of  the 
newer  educational  and  preventive  work 
which  is  being  recognized  to-day  as  the 
core  of  medical  helpfulness  to  the  pubhc 
as  a  whole.  To  fool  a  patient  is  tyranny, 
not  guidance.  He  must  understand  what 
is  being  done  for  him  if  he  is  to  do  his 
part  properly.  This  means  team-work  of 
doctor  and  patient. 

To  describe  the  changes  just  suggested 
whereby  medical,  social,  and  educational 
work  are  now  being  drawn  together  for 
the  public  good  is  the  object  of  this  book. 


CONTENTS 

PAGE 

I.     Backgrounds    and    Foregrounds    in 

Medical  Work  ....         3 

II.  The  Nature  of  Social  Work,  Espe- 
cially IN  Its  Relation  to  Medi- 
cine      32 

III.  Team-work  of  Doctor,  Educator, 
and  Social  Worker,  and  the  Re- 
sulting Changes  in  the  Three 
Professions — A  Review  and  a 
Programme 91 

IV.  Team-work  of  Doctor  and  Patient 
Through  the  Annihilation  of 
Lying 116 

V.     Social    Work    in    Hospitals;    the 

Palliation  of  Absent-mindedness     171 


SOCIAL  SERVICE 

AND  THE 

ART  OF  HEALING 


SOCIAL  SERVICE  AND  THE 
ART  OF  HEALING 

CHAPTER  I 

BACKGROUNDS  AND  FOREGROUNDS  IN 
MEDICAL  WORK 

There  are  two  kinds  of  blindness  from 
which  I  have  suffered  in  my  medical  work. 
As  I  am  now  beginning  to  be  convalescent, 
I  note,  with  the  sensibility  of  the  recent 
sufferer,  similar  misfortunes  in  those 
around  me.  Bhndness  to  what  is  before 
you  just  this  minute  and  never  before,  or 
bhndness  to  foregrounds,  is  a  very  com- 
mon disease,  due  to  the  habit  of  looking 
off  into  the  distance  over  the  head  (as  it 
were)  of  the  fact  before  you. 

But  there  is  another  type  of  blindness 
in  which  the  sufferer  can  see  nothing  ex- 


4.  SOCIAL  SERVICE  AND 

cept  the  facts  directly  in  front  of  his  nose ; 
this  I  call  bhndness  to  backgrounds.  I 
will  mention  a  group  of  examples  of  each 
type. 

I 
In  my  medical  work  at  the  Massachu- 
setts General  Hospital  I  used  to  see  about 
30  patients  a  day,  or  3,000  in  my  four 
months'  service.  As  I  sit  in  my  chair  be- 
hind the  desk,  Abraham  Cohen,  of  Salem 
Street,  approaches,  and  sits  down  to  tell 
me  the  tale  of  his  sufferings;  the  chances 
are  ten  to  one  that  I  shall  look  out  of  my 
eyes  and  see,  not  Abraham  Cohen,  but  a 
Jew;  not  the  sharp,  clear  outlines  of  this 
unique  sufferer,  but  the  vague,  misty  com- 
posite photograph  of  all  the  hundreds  of 
Jews  who  in  the  past  ten  years  have  shuf- 
fled up  to  me  mth  bent  back  and  deprecat- 
ing eyes,  and  taken  their  seats  upon  this 
same  stool  to  tell  their  story.  I  see  a 
Jew, — a  nervous,  complaining,  whimper- 
ing Jew, — with  his  beard  upon  his  chest 


THE  ART  OF  HEALING  5 

and  the  inevitable  dirty  black  frock-coat 
flapping  about  his  knees.  I  do  not  see  this 
man  at  all.  I  merge  him  in  the  hazy  back- 
ground of  the  average  Jew. 

I  look  behind,  beyond,  through  this 
actual  flesh-and-blood  man,  to  my  own 
habitual  mental  image  of  what  I  expect  to 
see.  Perhaps,  if  I  am  a  little  less  blind  than 
usual  to-day,  I  may  hear  what  he  says  in- 
stead of  what  I  expect  him  to  say.  I  may 
notice  something  in  the  way  his  hand  lies 
on  his  knee,  something  that  is  queer,  un- 
expected. That  hand, — that  hand,  why, 
it's  a  muscular  hand,  it's  a  prehensile  hand ; 
and  whoever  saw  a  Salem  Street  Jew  with 
a  muscular  hand  before?  That  shocks  me 
awake,  at  last.  This  is  not  merely  *^^  a 
Jew  " :  this  is  a  new  kind  of  Jew.  Why, 
his  eyes  are  farther  apart  than  I  ever  saw 
before  in  a  Hebrew,  and  they  don't  avoid 
mine,  but  look  straight  at  me  with  a  long, 
deep  look  that  somehow  reminds  me  of  the 
child    in    Raphael's     Sistine    Madonna. 


6  SOCIAL  SERVICE  AND 

They  are  blue  eyes,  thunder-cloud  blue 
and  very  steady. 

All  this  time  he  has  been  talking  to 
me,  not  about  himself,  but  about  his  fi- 
ancee whom  I  have  examined  and  found 
consumptive  yesterday.  "  Is  she  cur- 
able?" he  asks,  and  "Would  Colorado 
give  her  the  best  chance?  How  soon  must 
she  go, — before  cold  weather?  Well,  I 
tliink  I  can  arrange  it  before  that.  I  have 
a  little  business  just  established  in  Provi- 
dence, but  I  think  wdthin  a  month  I  can 
sell  it  out,  and  take  her  to  Denver  or 
wherever  is  best." 

"  And  what  will  you  do  out  there? "  I 
asked  him.  "  Have  you  any  friends  to 
help  you  start  in  business?  " 

"  Oh,  I  guess  I'm  strong  enough  to  sup- 
port two,"  he  said.  "I  can  work  in  the 
mines  if  there  is  nothing  else."  He  saw 
nothing  out  of  the  way  in  giving  up  the 
retail  dry-goods  business  which  he  had  just 
got  well  under  way  in  Providence,  and 


THE  ART  OF  HEALING  7 

going  to  work  underground  in  the  dark- 
ness of  a  mine,  if  there  was  any  chance  of 
saving  his  fiancee,  the  dried-up,  mincing 
Httle  milHner  whom  I  had  seen,  or  thought 
I'd  seen,  the  day  before.  There  was  no 
certainty  that  he  could  save  her.  I  told 
him  that;  but  as  soon  as  he  understood 
that  there  was  a  chance,  he  was  off  to  make 
his  arrangements.  He  has  gone  now  out 
into  that  unknown  country,  made,  I  hope, 
a  Httle  less  forlorn  and  friendless  to  him 
by  some  letters  I  was  able  to  give  him 
to  friends  in  Denver  and  Colorado 
Springs. 

You  could  never  forget  that  man  if  you 
had  seen  him, — his  eyes,  his  quiet,  slow 
voice,  his  muscular  hands.  I  saw  him. 
Yet  he  was  no  more  real  than  the  thou- 
sands of  others  whom  I  have  seen  and  for- 
gotten,— forgotten  because  I  never  saw 
thenij  but  only  their  ghostly  outline,  their 
generic  type,  the  racial  background  out  of 
which  they  emerged. 


8  SOCIAL  SERVICE  AND 

The  pity  of  it  is  that  we  see  only  what 
we  have  seen  before.  But  the  man,  him- 
self, is  just  precisely  that  which  I  have 
never  seen  before.  So  he  is  for  me  in- 
visible: to  him,  as  he  sees  himself,  I  am 
usually  blind.  I  see  a  case  of  phthisis  in 
a  sad-eyed  Irishman,  but  I  cannot  see,  as 
he  does,  his  children  at  home,  the  coldness 
of  his  employer  when  he  asks  if  his  job 
can  be  kept  for  him,  the  dreariness  of  this 
great  hospital  with  its  suggestion  of  name- 
less horrors  behind  doors  which  open  for  a 
moment  and  are  s^viftly  closed  again. 
The  self  that  is  pushing  painfully  through 
these  experiences  I  fail  to  see,  though  it 
is  all  written  in  the  stoop  of  his  shoulders, 
the  fear  in  his  eyes,  and  the  swift  snatches 
of  hesitating  speech  as  he  questions  me 
about  his  lungs. 

My  students  cannot  even  hear  the  new- 
sound  which  I  hear  over  one  spot  in  his 
lungs, — a  sound  I  never  heard  before. 
The  students  hear  only  the  old  common 


THE  ART  OF  HEALING  9 

sounds  which  every  case  of  advanced 
phthisis  shows.  These  familiar  old  sounds 
they  promptly  hear  and  record,  but  to 
this  new  and  startling  sound,  which  might 
be  the  prelude  to  a  better  understanding 
of  phthisis,  they  are  deaf,  though  it  is  loud 
and  clear,  even  to  therrij  after  it  is  pointed 
out  to  them. 

It  is  very  humihating,  this  blindness  to 
the  new  facts,  but  it  is  a  disease  that  we 
all  have  in  greater  or  less  degree. 

II 

Let  me  tell  you  another  of  our  humiha- 
tions.  This  case  of  typhoid, — a  "  walking 
typhoid "  who  has  just  turned  up  late, 
near  lunch  time,  at  the  Out-Patient  De- 
partment, is  obviously  too  sick  to  go  home. 
We  must  keep  him  in  the  hospital. 
"  Well,  make  out  his  recommendation  slip, 
and  count  his  white  corpuscles;  ring  for 
John  and  the  wheel-chair,  and  get  his 
clothes  on,  and  don't  forget  to  record  the 


10  SOCIAL  SERVICE  AND 

dimensions  of  his  spleen  before  you  put 
his  record  slip  away." 

While  these  orders  were  being  given, 
and  while  half  a  dozen  assistants  were  ex- 
ecuting them,  a  visitor  to  the  hospital,  not 
yet  blinded  and  deafened  by  routine,  heard 
the  sick  man  ask  three  times  for  a  drink  of 
water.  The  visitor  heard  it:  the  others 
stood  just  as  near,  but  none  of  them  heard 
it.  The  sounds  of  his  voice  struck  the 
tympanum  of  each  man's  ear,  but  to  three 
of  them  it  was  an  unusual  request,  and  so 
was  simply  unheard ;  by  two  others  it  was 
heard,  but  disregarded,  not  because  they 
were  cruel-hearted, — not  at  all, — ^but  be- 
cause they  were  none  of  them  assigned  to 
that  duty.  It  was  no  one's  business  in 
particular,  and  they  all  had  other  jobs — 
though,  to  be  sure,  jobs  which  could  wait. 
One  other  assistant  who  heard  the  request 
said  to  himself,  "  Oh,  he'll  be  in  the  ward 
in  half  an  hour,  and  get  plenty  of  cooler 
water;  and  what  possible  difference  can 


THE  ART  OF  HEALING  11 

it  make  in  his  recovery  anyhow?  He'll 
want  water  again  in  a  few  hours."  So  no 
one  stirred  to  get  him  the  water  until  the 
visitor  could  bear  it  no  longer,  and  so 
hunted  up  the  tumbler  and  faucet,  and 
brought  it  himself.  Goodness!  to  see  the 
sick  man  down  that  glass  and  look  up 
with  the  gleam  of  momentary  rehef  was 
something  that  visitor  will  never  forget, 
and  wouldn't  have  missed  for  a  year's  Hfe. 
It  was  the  foreground, — immediate, 
pressing,  wholly  transient  rehef,  direct 
personal  service  of  the  simplest  kind, — all 
hidden  from  the  minds  of  the  regular  as- 
sistants because  they  were  looking  off  into 
the  distance,  shaping  the  sufferer's  future 
course  to  the  ward  and  towards  recovery, 
each  pointing  hke  a  dog  at  his  task,  each 
put  in  bHnders,  hke  a  horse,  by  his  con- 
centration on  the  future  and  the  distant. 
All  concentration  is  perilously  near  to 
blindness  outside  the  circle  which  is  Ht  up 
by  the  lamp  of  attention.     The  concen- 


12  SOCIAL  SERVICE  AND 

trated  beam  of  the  searchlight  on  a  battle- 
ship is  typical  of  the  mind  of  a  busy,  well- 
trained,  unimaginative  man.  Any  well- 
trained  physician,  as  he  looks  with  one  eye 
through  a  microscope,  keeps  the  other  eye 
open,  not  closed,  as  the  beginner  does,  but 
wide  open  and  perfectly  blind,  absolutely 
unaware  of  the  images  that  fall  upon  it. 

So  foregrounds  always  tend  to  be  in- 
visible to  the  man  whose  mind  is  else- 
where, intent  upon  its  duties  and  its  plans. 

Sometimes  an  immediate  crying  need, 
like  that  of  the  thirsty  fever  patient,  is 
disregarded,  because,  as  we  say,  it  is  so 
transient^ — so  momentary  is  the  rehef  we 
give.  "  He'U  be  tliirsty  again  in  half  an 
hour,  and  water  won't  cure  him,  anyway." 
Yes.  It  is  now  and  here.  It  does  not 
stretch  into  the  distant  future.  In  other 
words,  it  is  just  what  I  have  called  it,  a 
foreground,  and  we  are  dreadfully  prone 
to  forget  that  all  eternity  is  made  up  of 
half -hours  as  transient  as  this,  as  simple, 


THE  ART  OF  HEALING  13 

unimpressive,  and  insignificant  as  this. 
Nothing  divine,  nothing  heroic,  about  this 
mean,  commonplace  present.  If  the  occa- 
sion were  imposing  and  resounding,  we 
should  rise  to  it  nobly,  but  we  notice  noth- 
ing very  important  just  here  in  this  dingy 
laboratory  or  on  that  dreary  corridor. 
We  are  almost  indignant,  if  anyone  tries 
to  open  our  eyes.  How  can  this  piece  of 
cheap,  transient  drudgery  be  hnked  to 
anything  noble  or  significant  ? 

"  Lord,  when  saw  we  thee  an  hungered, 
or  athirst,  or  a  stranger,  or  naked,  or  sick, 
or  in  prison,  and  did  not  minister  unto 
thee?" 

Whatever  we  think,  whatever  our  creeds 
say,  our  acts  prove  that  we  count  it  mere 
poetic  exaggeration  or  literary  figure 
when  Christ  said,  "  Inasmuch  as  ye  did  it 
not  unto  one  of  these  least,  ye  did  it  not 
unto  me."  Christ  said  that  every  person, 
every  moment,  is  a  representative  of  the 
best  in  Hfe, — a  fair  specimen  opportunity. 


U  SOCIAL  SERVICE  AND 

"  One  of  the  great  illusions  is  that  the 
present  hour  is  not  the  critical,  decisive 
hour.  God  give  me  insight  into  to-day! 
The  meal  in  the  firkin,  the  milk  in  the  pan, 
the  ballad  in  the  street,  the  glance  of  the 
eye,  the  form  and  gait  of  the  body;  show 
me  the  sublime  presence  lurking,  as  it 
always  does  lurk,  in  these  suburbs  and  ex- 
tremities of  nature." 

"  Inasmuch  as  ye  did  it  unto  the  least 
of  these  my  brethren,  ye  did  it  unto  me." 

"  What  are  you  doing?  " 

"  Oh,  nothing.  I  have  been  doing  that, 
I  shall  be  doing  so  and  so,  but  just  now 
I  am  only  " — "  Inasmuch  as  ye  did  it  not 
unto  the  least  of  these  my  brethren,  ye  did 
it  not  unto  me." 

Ill 

From  another  point  of  ^dew  the  duty 
of  seeing  the  foreground  becomes  what 
Stevenson  calls  the  duty  of  happiness, 
IS'ot  merely  in  some  far-off  divine  event 


THE  ART  OF  HEALING  15 

which  shall  gloriously  consummate  and 
fulfill  the  hopes  of  to-day,  but  all  along 
the  road,  in  the  details  of  meeting,  serving, 
directing  our  patients,  in  the  very  process 
itself,  and  not  only  in  its  results,  we  must 
find  our  happiness.  Why  must  we?  Be- 
cause the  man  that  doesn't  enjoy  his  job 
never  does  it  well,  and  because,  if  you  do 
enjoy  it,  you  will  make  others  happy.  If 
it  is  only  the  fully  achieved  result  that  you 
enjoy,  you  will  be  glum  or  grim  most  of 
the  time,  for  results  are  rare  and  uncer- 
tain things,  and  the  "  best-laid  plans  of 
mice  and  men  gang  aft  agley."  One  ought 
to  enjoy  the  motion  of  walking  down  a 
corridor,  the  actual  questions  and  answers 
by  which  we  get  at  our  patients'  needs,  the 
simple  technique  of  accurately  reading  a 
thermometer  and  neatly  recording  the  re- 
sult on  a  chart.  One  ought  to  get  pleasure 
out  of  the  eyes  and  faces,  the  gestures  and 
tones,  of  our  patients  and  our  fellow- 
workers,  the  rich  roll  of  the  Scotchman's 


16  SOCIAL  SERVICE  AND 

brogue,  the  musical  undulations  of  the 
Enghsliman's  voice,  and  the  quick,  sym- 
pathetic flash  of  the  Itahan's  eye.  How 
stupid,  how  purblind,  to  front  all  these 
guests  with  the  same  stereotyped  kindness, 
the  same  military  precision,  or,  worst  of 
all,  the  same  dull  inattention!  Let  us  be 
in  it!  Let  us  catch  the  vital  impulse  of 
happiness  that  there  is  in  sight,  sound, 
and  touch,  in  the  infinite  novelty  and  un- 
expectedness of  the  foreground. 

This  unique  unforeseen  opportunity, 
this  direct  personal  service,  this  momen- 
tary joy  springing  from  the  sight  and 
sound  before  us,  make  up  a  part  of  that 
foreground  of  our  work  to  which  I  wish 
with  all  my  heart  I  could  never  again  be 
blind. 

There  is  much  else  in  that  foreground 
of  which  I  should  like  to  speak.  To  be 
blind  to  the  humor  of  the  moment  or  to 
the  pathos  and  the  tragedy  of  the  moment, 
to  meet  them  all  with  the  same  engaging 


THE  ART  OF  HEALING  17 

smile  or  the  same  businesslike  firmness, — 
oh,  it  is  a  performance  fit  only  for  lay 
figures  on  wheels !  God  grant  we  may  act 
to-morrow  a  Httle  less  like  stuffed  images ! 
No  wise  thought  of  the  future,  no  deep 
scientific  ardor  for  the  truth  to  be  learned 
from  these  sufferers,  no  preoccupation 
with  the  wider  interests  of  the  community, 
can  justify  our  bhndness  to  the  here  and 
now. 

IV 

But  I  should  wholly  miss  my  mark  if  I 
left  you  with  the  impression  that  I  hate 
blindness  to  foregrounds  a  whit  less  than 
I  hate  the  shortsightedness  that  can  see 
only  the  foreground. 

We  physicians  are  prone  to  scoff  at  the 
habit  of  taking  a  drug  for  a  symptom  Hke 
headache,  without  looking  deeper  to  find 
the  underlying  disorder  of  which  this 
headache  is  a  symptom.  We  point  out 
very  truly  that  only  by  finding  and  remov- 
ing the  cause  of  this  headache — an  eye- 


18  SOCIAL  SERVICE  AND 

strain,  perhaps,  or  a  stomach  trouble — 
can  its  recurrence  be  prevented  and  other 
disorders  nipped  in  the  bud.  This  is  as 
it  should  be,  but  we  need  to  carry  the  same 
habit  further.  Why  should  we  not  push 
on,  and  find  out  why  this  patient  has  the 
stomach  trouble?  The  headache  is  only  a 
symptom  of  stomach  trouble,  we  say. 
Yes,  but  the  stomach  trouble  itself  may 
be  only  a  symptom  of  chronic  worry,  and 
the  worry  a  symptom  of  deficient  income. 
The  patient's  expenses  turn  out  to  be  a 
trifle  larger  than  his  wages,  and  one  of  the 
many  bad  results  of  this  fact  is  the  worry 
that  causes  the  stomach  trouble,  which  in 
turn  causes  the  headache. 

If  we  are  really  to  treat  that  patient, 
and  not  merely  smother  one  of  his  symp- 
toms under  a  dose  of  medicine,  we  must 
push  on  into  the  background  of  his  case, 
and  see  what  disease  in  the  body  politic — 
perhaps  in  the  organization  of  industry — 
is  behind  his  individual  suffering.    Not  that 


THE  ART  OF  HEALING  19 

we  should  lose  sight  of  him.  On  the  con- 
trary, we  can  do  much  better  for  him  if, 
instead  of  stopping  at  the  first  stage,  head- 
ache; or  at  the  second  stage,  the  stomach 
trouble ;  or  even  at  the  third,  worry,  we  go 
into  the  matter  of  liis  income  and  outgo, 
and  see  if  the  two  ends  can't  be  made  to 
meet.  I  have  heard  physicians  giving  ad- 
vice to  patients  not  to  worry,  advice  that 
would  be  laughable  if  it  were  not  so  pa- 
thetic: "  Just  stop  worrying  "  (you  might 
just  as  well  say  stop  breathing),  "and 
take  a  long  rest.  Avoid  all  mental  and 
physical  strain."  What  his  wife  and  cliil- 
dren  are  to  do  meantime  never  occurs  to 
this  type  of  physician.  The  wife  and  chil- 
dren are  in  the  background,  out  of  range 
of  his  vision,  and  so  for  him  they  play  no 
part  in  the  case. 

The  shortsightedness  of  our  hospitals 
in  this  respect  is  really  marvelous.  They 
will  take  in  the  wards  a  baby  whose  diges- 
tion is  upset,  give  it  free  treatment,  which 


20  SOCIAL  SERVICE  AND 

costs  the  hospital  twenty  dollars,  send  it 
out  again  without  any  inquiry  into  the  way 
the  mother  feeds  it  or  the  air  it  breathes 
or  the  clothes  it  wears.  A  month  later  the 
baby  is  back  again,  as  sick  as  before,  and 
from  just  the  same  causes.  The  hospital 
takes  it  again,  spends  another  twenty  dol- 
lars in  getting  it  well,  and  so  on.  I  fol- 
lowed up  a  case  like  tliis  recently,  and 
found  that  the  mother  was  grossly  igno- 
rant of  the  first  principles  of  feeding  and 
caring  for  a  baby,  though  perfectly  ca- 
pable of  being  taught.  Even  in  terms  of 
dollars  and  cents  the  hospital  is  losing  by 
its  blindness  to  backgrounds.  The  same 
ailments  in  the  same  patients  are  treated 
again  and  again,  with  a  wisdom  equal  to 
that  of  the  sage  who  dipped  up  water  with 
a  sieve. 

Our  patients  shoot  by  us  like  comets, 
crossing  for  a  moment  our  field  of  vision, 
then  passing  out  into  oblivion.  At  the  end 
of  hundreds  of  hospital  records  one  can 


THE  ART  OF  HEALING  21 

read  the  words  "  Discharged  well,"  and 
the  eminent  surgeon  figuring  up  his  "  suc- 
cesses," often  counts  as  such  all  who  have 
left  the  hospital  well,  and  never  been  heard 
from  again.  But  peer  into  the  back- 
ground a  little,  follow  up  these  cases  for  a 
few  months  or  years,  and  you  will  often 
find  that  "  the  last  state  of  that  man  was 
worse  than  the  first."  The  past  and  the 
future  of  our  cases  is  one  aspect  of  that 
background  of  their  hves  to  which  we  are 
so  bhnd. 

V 

Another  background  of  our  experience 
with  the  sick,  and  one  to  which  we  are 
almost  as  blind  as  we  are  to  their  home 
conditions,  is  the  moral  and  spiritual  set- 
ting from  which  their  physical  symptoms 
project  into  our  foreground.  This  is  the 
field  in  which  our  friends  the  JVIental  Heal- 
ers and  Christian  Scientists  have  worked 
with  so  much  success.  Mind  Cure  and 
Christian  Science  have  a  strong  hold  upon 


22  SOCIAL  SERVICE  AND 

thousands  in  this  community  to-day  be- 
cause they  have  not  been  Wind  to  the 
spiritual  background  of  physical  suffer- 
ing. Doctors  and  nurses  used  to  be  un- 
^^dlling  to  admit  that  fear  causes  disease 
because  the  JNIind  Curists  have  so  long 
said  that  it  did,  but  now  there  is  scarcely 
a  week  in  w^iich  you  will  fail  to  find  upon 
several  of  the  record  shps  in  our  Out- 
Patient  Department  the  diagnosis,  '' Ap- 
prehension f 

A  man  comes  to  us  complaining  of  a  tri- 
fling pain  in  his  chest,  but  also  sleepless, 
without  appetite,  losing  weight,  too  weak 
to  work, — all  because  the  trifling  pain 
happens  to  be  in  the  spot  where  he  has  been 
told  liis  heart  is.  I  examine  his  heart,  find 
it  wholly  normal,  tell  him  so  with  all  the 
emphasis  I  can  express,  and  add  that  he 
couldn't  die  if  he  tried,  will  probably  live 
to  be  a  hundred,  and  that  meantime  he 
must  go  to  work  and  put  the  idea  of  heart 
trouble  out  of  liis  head  once  for  all.    In 


THE  ART  OF  HEALING  23 

three  days  that  man  will  be  a  changed 
being.  You  will  hardly  recognize  him  as 
the  same.  He  believed  me  because  he 
heard  me  tell  the  patient  just  ahead  of 
him  that  he  had  heart  trouble,  and  could 
never  hope  to  work  again.  BeHeving  me, 
he  began  to  sleep  and  eat,  to  work,  to  love 
life,  and  to  throw  from  his  shoulders  the 
millstone  of  fear  that  had  been  weighing 
him  down. 

Every  candid  physician  knows  that  fear 
causes  some  disorders,  that  self-absorption 
causes  others,  that  sin  and  half-smothered 
remorse  cause  still  others.  But  he  is 
afraid  to  admit  the  full  consequences  of 
these  truths.  Because  he  knows  that  can- 
cer, typhoid,  meningitis,  are  not  caused  by 
fear  or  by  sin,  because  he  fears  to  admit 
that  the  Mind  Curists  have  a  piece  of  real 
truth  in  their  possession,  he  blinds  himself 
to  this  whole  realm  of  fact.  He  calls  it 
rubbish  or  sentimentality  or  superstition 
or  simple  ignorance,  but  he  has  to  recog- 


24  SOCIAL  SERVICE  AND 

nize  it  more  or  less  in  his  practice,  though 
grudgingly. 

The  enormous  influence  of  spiritual  en- 
vironment, of  friendship,  of  happiness,  of 
beauty,  of  success,  of  religion,  is  griev- 
ously, ludicrously  underestimated  by  most 
physicians,  nurses,  and  hospital  superin- 
tendents. There  are  diseases  that  cannot 
be  cured  without  friendship,  patients  that 
never  will  get  well  unless  you  can  get 
them  to  make  a  success  of  something  or 
to  conquer  their  own  self-absorption 
by  a  self-devotion,  losing  their  hfe  to 
find  it. 

Our  blindness  to  backgrounds  of  this 
type  is  well  illustrated  by  the  recent  re- 
mark of  a  hospital  superintendent :  "I 
want  you  to  understand,"  he  said, — to 
someone  who  was  laboring  to  correct  some 
of  the  results  of  our  habitual  bhndness  to 
backgrounds — "  I  want  you  to  under- 
stand that  we  want  sense,  and  not  senti- 
ment, in  this  work."    Think  of  the  short- 


THE  ART  OF  HEALING  25 

sightedness  of  one  who  has  lived  for  years 
in  the  midst  of  these  problems, — your 
problems  and  mine, — yet  doesn't  know 
that  both  sense  and  sentiment  are  abso- 
lutely essential  in  any  competent  medical 
work.  It  is  as  if  one  should  say,  "  We 
want  eyes,  but  no  ears,  in  this  work." 

VI 

Another  type  of  blindness  to  back- 
grounds, and  one  less  appeahng  perhaps 
to  most  of  us,  is  the  blindness  to  the  scien- 
tific truth  which  can  and  ought  to  be  won 
out  of  every  case  of  poverty,  ignorance, 
or  disease.  Now,  I  hope  you  will  not 
suspect  me  of  lack  of  respect  for  the  hu- 
manitarian side  of  medicine,  the  direct 
immediate  helpfulness  of  man  to  man, — 
in  short  the  foreground.  But  I  wonder 
if  we  all  realize  that  Pasteur,  who  had 
scarcely  any  direct  dealings  with  patients, 
scarcely  entered  what  I  call  the  fore- 
ground of  medical  work,  won  truth  that 


26  SOCIAL  SERVICE  AND 

has  been  the  means  of  sa^dng  more  lives, 
more  suffering,  more  rack  and  ruin  in  hu- 
man flesh,  than  all  the  doctors  and  nurses 
and  social  workers  now  living.  It  is  the 
man  of  science  who  works  out  the  preven- 
tion of  typhoid  epidemics,  banishes  yellow 
fever  from  Cuba  and  the  terrible  parasitic 
anemia  from  Porto  Rico.  You  and  I  can 
only  alle^date  a  little  suffering  here  and 
there.  We  are  pygmies  of  human  help- 
fulness compared  to  those  giants  who  look 
beyond  and  beliind  the  sick  patient  in  the 
foreground,  to  the  tiny  glimpse  of  truth 
in  the  far  distance,  and  work  towards  that 
distant  gleam  by  faith.  I  want  to  make 
you  feel  as  I  do  the  spiritual  nobihty  of 
scientific  work.  It  deals  almost  exclu- 
sively ^^ith  the  unseen.  You  and  I  deal 
\\ith  the  seen,  ^rith  the  ills  and  griefs  of 
the  foreground,  and  we  are  quite  right  in 
doing  so,  but  we  ought  to  give  all  honor  to 
the  spiritual  imagination  by  means  of 
which  the  man  of  science  grasps  those  un- 


THE  ART  OF  HEALING  27 

seen  truths  which  are  eternal,  and,  using 
them  as  a  lever,  lifts  us  all  out  of  our  diffi- 
culties.    Let  me  illustrate. 

It  was  a  mere  idea,  a  mere  theory,  for 
which  Lazear  laid  down  his  life  five  years 
ago  in  Cuba, — the  theory  that  mosquitoes 
transmitted  yellow  fever  from  man  to 
man.  Nothing  visible,  nothing  reliable 
and  certain  in  it.  To  test  it,  men  must  be 
found  who  would  allow  themselves  to  be 
bitten  by  mosquitoes  which  had  previously 
bitten  a  yellow-fever  patient.  Lazear  and 
three  other  physicians  were  bitten,  and  by 
their  example  induced  several  others  (sol- 
diers in  the  American  army)  to  do  the 
same.  All  were  infected,  all  took  yellow 
fever.  The  theory  was  proved,  and  La- 
zear died.  To-day,  and  as  a  direct  result 
of  the  scientific  work  that  culminated  in 
the  sacrifice  of  Lazear's  life,  Cuba  is  free 
from  yellow  fever  after  one  hundred  and 
fifty  years  of  the  scourge. 

Those   doctors   did  not   directly  serve 


28  SOCIAL  SERVICE  AND 

any  patient.  They  nursed  no  one,  they  car- 
ried no  cup  of  cold  water.  In  books  and 
laboratories  they  imagined,  thought  out, 
worked  out,  and  proved  that  theory.  As 
we  look  back  now  from  the  solid  ground 
of  assured  fact,  with  New  Orleans  saved 
three  years  ago  from  decimation  owing  to 
the  application  of  this  theory,  it  is  hard 
to  realize  the  imagination,  the  faith,  the 
hold  upon  the  unseen,  wliich  went  to  the 
elaboration  of  that  theory.  "  Faith,"  says 
Saint  Paul,  "  is  the  substance  of  things 
hoped   for,    the   evidence   of   things   not 


seen." 


You  would  realize  the  high  spiritual 
quality  of  this  work  if  you  were  associated 
with  the  men  who  do  it.  Do  you  remem- 
ber Scott's  description  of  the  Round- 
heads in  "  Old  Mortahty," — the  lean, 
bare-headed  group  upon  the  hill,  utterly 
wanting  in  the  graces  and  trappings  of  the 
Cavaliers,  poor  and  mean,  silent,  un- 
worldly, shining  only  by  the  inner  light  of 


THE  ART  OF  HEALING  29 

their   determined   purpose   and   of   their 
abounding  faith  in  the  unseen? 

That  is  the  type  evolved  by  scientific 
discipline,  a  discipKne  the  full  rigor  of 
which  must  be  experienced  to  be  appreci- 
ated. If  ever  you  feel  inchned  to  beHttle 
the  work  of  scientific  men,  or  to  believe 
the  legends  of  their  brutahty  and  material- 
ism, go  and  look  into  the  faces  of  any  gath- 
ering of  them,  and  hsten  to  their  work. 
I  think  you  will  be  convinced,  as  I  am,  that 
no  small  part  of  the  seed  of  the  God-fear- 
ing Puritans  has  taken  root  and  is  flour- 
ishing in, the  rigorous  asceticism  of  the 
modern  scientific  investigator.  We  accept 
the  fruits  of  his  labors,  and  live  on  them 
like  parasites,  but  we  do  not  often  stop  to 
acknowledge  our  indebtedness,  still  less  to 
reahze  that  the  work  has  been  done  by 
minds  disciplined  by  a  degree  of  self- 
denial,  a  degree  of  renunciation  of  the 
world  and  its  rewards,  before  which  you 
and  I  should  quail. 


30         .    SOCIAL  SERVICE  AND 

VII 

I  have  set  foreground  and  background 
apart,  and  described  them  separately,  as 
if  it  were  true  that  the  more  one  sees  of  the 
one,  the  less  the  other  is  visible.  But,  of 
course,  that  is  not  so.  The  man  who  has 
a  clear  sense  of  the  individuality  and 
sacredness  of  each  person  and  each  mo- 
ment of  time  will  yet  run  into  confusion 
and  distortion  unless  he  backs  his  fore- 
ground view  with  the  vista  of  the  distant^ 
the  past  and  the  future,  the  background  of 
the  community  life  out  of  which  this 
individual  has  emerged  and  to  which 
he  belongs.  The  only  justice  to  one  in- 
dividual is  justice  to  all.  The  only  true 
consideration  of  one  is  consideration 
of  all. 

The  humanitarian  and  the  scientific 
sides  of  our  work  need  each  other  as  man 
and  woman  do.  Science  without  humanity 
becomes    arid   and,    finally,    discouraged. 


THE  ART  OF  HEALING  31 

Humanity  without  science  becomes 
scrappy  and  shallow. 

No  one  ought  to  be  satisfied  to  test  his 
work  by  any  easier  standards  than  these: 

First,  Am  I  seeing  all  the  actual  facts, 
the  ever-new  and  unique  facts,  the  crying 
and  immediate  needs  as  they  come  before 
me? 

Second,  Am  I  tracing  out  as  far  and 
as  deep  as  I  can  the  full  bearing,  the  true 
lesson,  the  unseen  spirit  of  tliis  moment, 
this  situation,  this  calamity,  this  illness? 

Am  I  using  my  eyes  and  ears,  my  sym- 
pathies and  my  imagination,  as  hard  as  I 
can?  Am  I  searching  for  the  deepest 
meaning,  the  widest  bearing,  the  furthest 
connection  of  these  facts?  Am  I  seeing 
and  helping  as  truly  as  I  can  the  fore- 
ground and  the  background  of  my  work? 


CHAPTER  II 

THE  NATURE  OF  SOCIAL  WORK,  ESPECIALLY 
IN    ITS    RELATION    TO    MEDICINE 

As  soon  as  we  open  our  eyes  to  the  back- 
grounds of  medical  work  such  as  I  exem- 
plified in  the  last  chapter,  social,  educa- 
tional, and  preventive  activities  begin  to 
loom  up  round  us  in  deep  vistas  which  we 
cannot  reasonably  refuse  to  explore.  A 
man  is  not  flat  like  a  card.  We  cannot 
get  the  whole  of  him  spread  out  upon  our 
retina  at  once.  The  bit  of  him  which  is 
recorded  in  the  history  of  his  aches,  his 
jumps,  and  his  weaknesses  is  built  into  the 
rest  of  his  life  and  character  like  a  stone 
in  an  arch.  To  change  any  part  of  him 
appreciably  we  must  change  the  whole. 
As  well  might  one  try  to  pick  up  a  man's 
shadow  and  carry  it  away  as  to  treat  his 

33 


THE  ART  OF  HEALING  33 

physical  ills  by  themselves  without  knowl- 
edge of  the  habits  that  so  often  help  to 
make  him  sick  and  the  character  of  which 
these  habits  are  the  fruit. 

Yet  physicians  and  hospital  managers 
have  only  just  begun  to  realize  this 
because  the  inquiry  into  the  ultimate 
causes  and  results  of  disease  has  not  yet 
gathered  much  momentum.  The  question  : 
"  Why  does  this  disease  occur  at  all?  "  is 
still  thought  of  as  one  which  a  few  paid 
officials  or  virtuous  amateurs  may  well  be- 
stir themselves  to  answer,  provided  they 
have  the  time  and  provided  they  do  it  with- 
out disturbing  the  practical  work  of  the 
busy  physician.  The  average  practitioner 
is  used  to  seeing  his  patients  flash  by  him 
like  shooting  stars — out  of  darkness  into 
darkness.  He  has  been  trained  to  focus 
upon  a  single  suspected  organ  till  he  thinks 
of  his  patients  almost  hke  disembodied 
diseases. 

"  What  is  there  in  the  waiting-room?  " 


34  SOCIAL  SERVICE  AND 

I  asked  my  assistant  as  I  arrived  one 
morning  at  the  hospital. 

"  A  pretty  good  lot  of  material,"  said  he 
briskly.  "  There's  a  couple  of  good  hearts, 
a  big  hver  with  jaundice,  a  floating  kid- 
ney, three  pernicious  ansemias,  and  a  flat- 
foot." 

Among  such  flying  fragments  as  these 
the  physician  has  to  pass  his  days.  He 
couldn't  earn  a  living  if  he  did  not  attend 
first  and  cliiefly  to  the  part  that  is  thrust 
before  him.  He  must  clip  very  close  the 
wings  of  his  curiosity  as  to  the  ''  whence  " 
and  the  ''  whither ''  of  these  apparitions. 

When  a  bloody  finger  is  presented  to 
him  for  relief  he  looks  far  enough  to  see 
that  it  is  attached  to  an  arm  and  the  arm 
to  a  body  of  average  shape  and  carriage. 
Beyond  that  he  cannot  afford  to  look. 
The  finger  waits  for  attention.  His  work 
calls.  He  cannot  be  looking  off  into  space 
for  causes  and  results.  He  must  get  busy, 
and  as  he  does  so  a  mist  settles  down  along 


THE  ART  OF  HEALING  35 

these  puzzling  vistas.  Those  who  have 
time  can  ask  "  how  it  happened."  That 
is  not  his  business,  for  the  accident  must 
be  attended  to  however  it  happened.  The 
finger  must  be  dressed  whoever  owns  it; 
and  as  soon  as  it  is  bandaged  and  splinted, 
there's  a  boil  to  be  opened,  a  sprain  to  be 
examined,  some  ether  to  be  given,  and  so 
on  through  a  day,  a  week,  a  year.  Brief, 
isolated  arcs  in  the  span  of  a  human  hfe, 
accidents,  fragments,  each  crowding  out  the 
last — never  a  whole,  a  finished  day,  or  a 
story  completed — that's  the  doctor's  hfe,  as 
it  tends  to  be — tends  wdth  all  the  strength 
of  the  pressure  brought  to  bear  on  him  by  a 
public  hungry  for  immediate  relief, — any 
rehef,  "  but  be  quick  about  it,"  and  by  the 
need  to  earn  a  hving  and  support  a  family 
in  decent  comfort. 

If  disease  were  mostly  ''  accident "  and 
"  hard  luck "  or  "  too  bad "  as  we  are 
prone  consolingly  to  assure  one  another 
that  it  is,  my  plea  would  be  nonsense  and 


36  SOCIAL  SERVICE  AND 

tliis  book  would  never  have  been  written. 
If  sickness  usually  fell  from  the  clouds 
and  floored  man  like  the  lightning  stroke 
there  would  be  no  use  in  hunting  for  ulti- 
mate causes  in  the  victim's  character,  in- 
heritance or  environment,  no  sense  in  prat- 
ing of  social  or  educational  work  in  con- 
nection with  the  healing  art.  It  is  because 
the  sphere  of  accident  is  becoming  more 
and  more  contracted  that  the  importance 
of  social,  psychical,  and  educational  causes 
looms  up  larger  and  larger  every  year. 
Disease  is  not  often  "  hard  luck  "  nor  "  too 
bad."  For  the  most  part  it  is  as  bad  as  we 
— the  tax-payers — allow  it  to  be  and  as  we 
— the  unconquerable  soul  of  us — recognize 
it  to  be.  Preventable  disease  stares  us  in 
the  face.  Yet  still  the  rank  and  file  of  the 
medical  profession  are  too  busy  with  cases 
of  disease  (a  ''  case  ''  means  an  accident) 
to  have  time  for  causes.  It  is  only  when 
the  social  workers  stir  us  into  action 
that  the  Anti- Tuberculosis  crusade  and 


THE  ART  OF  HEALING  37 

the  Clean  Milk  crusade,  the  Pure  Food 
law,  the  Playground  Association,  and  the 
School  Hygiene  agitation  come  into  being. 

Why,  then,  does  not  the  social  worker 
get  the  credit  that  he  deserves  from  all  of 
us,  physicians,  parents,  and  citizens,  who 
have  reason  to  thank  him  for  the  most  and 
the  best  of  pubhc  health  work  and  pre- 
ventive medicine? 

Why  is  it  that  lawyers,  business  men, 
"  hard-headed "  people  generally  look 
upon  the  social  worker  as  belonging  "  mid- 
way between  the  dancing  master  and  the 
theologian  " — among  the  luxuries  and  the 
trifles,  the  dreams  and  impracticalities? 

I  beheve  the  answer  is  found  in  the  fact 
that  social  work  as  a  profession  is  new.  It 
has  evolved  out  of  more  or  less  haphazard 
alms-gi^dng  and  spasmodic  benevolence, 
out  of  Utopian  philanthropy  and  priestly 
"  good  works."  The  motives,  the  efforts, 
and  (here  and  there)  the  superbly  ef- 
fective practice  of  social  work, — all  this 


3.8  SOCIAL  SERVICE  AND 

is  ancient  and  tolerably  familiar;  but  the 
organization  of  these  eif  orts  into  a  definite 
profession,  trained,  paid,  and  recognized 
hke  engineering,  medicine,  or  law,  is  a 
matter  of  hardly  more  than  a  decade. 

Even  now  I  think  the  value  of  the  social 
worker  and  his  proper  recognition  are  con- 
siderably Kmited  by  the  fact  that  he  can- 
not often  recognize  himself  or  tell  you 
what  the  value  of  his  profession  is.  He  is 
an  expert.  But  in  what  is  he  an  expert? 
What  is  his  special  field  of  knowledge  and 
of  skill? 

I  want  in  this  chapter  to  attempt  an  an- 
swer to  this  question  because  I  think  that 
the  public  will  not  get  the  best  service 
either  out  of  doctors,  or  out  of  social 
workers,  until  the  close  relationship 
of  these  two  professions  is  generally 
recognized. 

In  my  opinion,  medical  and  social  work- 
ers must  act  together  as  a  team,  if  they 
are  to  serve  the  pubhc  efficiently.    But  this 


THE  ART  or  HEALING  39 

they  cannot  do  till  they  recognize  and  the 
public  recognizes  their  affinity. 

I 
What  is  Social  Work? 

"  Philanthropy  "  and  "  charity  "  are  its 
poor  but  honest  parents.  From  their 
point  of  view  we  may  naturally  approach 
its  definition — beginning  with  negatives. 

(a)  We  may  assume  in  the  first  place 
that,  in  the  evolution  of  the  conception  of 
philanthropy,  we  have  left  behind  the  stage 
at  which  a  fair  sample  of  the  morning's 
work  was  the  round  of  visits  made  by  the 
rich  and  kindly  lady,  with  her  basket  of 
choice  victuals,  virtuously  dispensed  to 
her  beneficiaries,  "  the  poor."  We  no 
longer  need  to  expose  and  refute  the  twin 
delusions : 

That  philanthropy  is  especially  merito- 
rious work. 

That  philanthropy  is  easy,  provided  our 
motives  are  good. 


40  SOCIAL  SERVICE  AND 

To-day  we  all  abhor  the  patronizing  atti- 
tude in  theory,  if  not  always  in  practice, 
and  we  have  had  it  effectually  brought 
home  to  us  that  it  is  hard  to  do  good  and 
easy  to  do  harm  in  social  work. 

It  is  never  safe  to  suppose  that  a  stage 
of  growth  which  we  have  left  behind  us 
is,  therefore,  to  be  dropped  bodily  out 
of  our  theory  and  our  practice.  There 
is  a  good  in  that  old  "  I  am  better  than 
thou  "  attitude ;  truth  in  the  de  haut  en  has 
treatment  of  the  social  sufferer; — what 
good,  what  truth,  I  shall  try  to  indicate 
later  in  my  .address. 

(b)  But  the  error  and  harm  of  these 
methods  are  more  obvious  than  the  truth  of 
them.  Stung  by  this  fact,  philanthropists 
have  striven  in  the  next  stage  of  evolution 
to  democratize  social  work.  "  Not  alms, 
but  a  friend,"  becomes  our  motto,  as  we 
come  to  recognize  that  by  the  giving  of 
money,  food,  and  clothes  we  can  easily  do 
harm,  while  much  more  often,  by  the  giv- 


THE  ART  OF  HEALING  41 

ing  of  friendly  advice,  sympathy,  and  en- 
couragement, or  simply  by  "  lending  a 
hand,"  we  may  be  of  use.  Realizing  that 
anyone  who  is  being  treated  coldly,  as  an 
inferior,  an  outcast,  and  an  opportunity 
for  the  "  acquisition  of  merit,"  is  not  hkely 
to  get  any  good  out  of  the  transaction,  we 
try  to  make  our  common  humanity  a  meet- 
ing ground  on  which  we  may  do  some  serv- 
ice.   "  Not  alms,  but  a  friend." 

But  this  second  conception  of  charity 
as  simple  friendhness  is  also  becoming  out- 
grown. It  is  good  as  far  as  it  goes,  but 
there  are  two  obvious  flaws  in  it: 

First,  wise  friends,  skillful,  experienced, 
and  foresighted  friends,  are  rare,  and  any 
other  kind  of  friends  may  be  useless  or 
worse  in  the  difficult  tasks  of  social  work. 
Mere  friendliness  will  not  do.  "  Friendly 
visiting  "  is  a  term  as  applicable  to  the 
physician's  work  as  to  the  philanthropist's. 
Both  make  friendly  visits :  each  also  does 
his  own  more  specific  service. 


4^.  SOCIAL  SERVICE  AND 

Second,  friends  are  not  made  in  a  day 
or  a  month.  The  skilled  social  worker 
may,  in  the  end,  succeed  in  becoming  the 
friend  of  those  who  need  his  help,  but  in 
the  long  intervening  time  which  must 
elapse  before  genuine  friendship  emerges, 
we  must  have  some  spiritual  modus  Vi- 
vendi, some  reason  other  than  friendship, 
other  than  friendliness,  for  meeting  at  all. 
The  attitude  in  which  one  person  regularly 
gives  and  seldom  receives  help,  the  one- 
sided relation,  is  not  friendship  and  tends 
only  very  slowly  to  the  growth  of  friend- 
ship. I  take  it  that  all  of  us  are  glad  to 
to  see  that  the  word  "  friendship  "  is  com- 
ing to  be  less  hghtly  used,  that  we  are 
more  conscious  of  the  rarity  and  sacred- 
ness  of  the  relation,  and  of  the  time,  pa- 
tience, and  rare  good  fortune  necessary  for 
its  creation.  Letters  to  perfect  strangers 
beginning,  "  My  dear  friend,"  are,  I  hope, 
less  common  than  they  used  to  be.  The 
following  extract  from  the  Boston  Di- 


THE  ART  OF  HEALING  43 

rectory  of  Charities  was  written  in  1899 
and  remained  unchanged  until  1906, 
though  it  has  been  expunged  in  the  edition 
now  current: 

"  Personal  friendship  furnished  to  both 
sexes  and  all  ages  "  [by  a  certain  chari- 
table society!] 

The  wholesale  acquisition  of  "  friends  " 
by  the  dozen  a  week  is  going  out  of 
fashion. 

Where,  then,  shall  we  look  for  that 
spiritual  standing-ground  on  which  the  so- 
cial worker  may  meet  those  who  need  his 
help,  without  a  patronizing  air,  but  also 
without  blaspheming  the  sacred  name  of 
friend?  Is  such  a  standing-ground  al- 
ready anywhere  in  use?  Where  shall  we 
look  to  find  pleasant,  healthy,  manly, 
democratic  relationships  maintained  be- 
tween persons  differing  sharply  in  inherit- 
ance, education,  habits,  and  en^dronments, 
between  rich  and  poor,  wise  and  ignorant, 
cultivated  and  uncultivated? 


44  SOCIAL  SERVICE  AND 

( c )  We  may  answer  with  IMr.  Brackett, 
head  of  the  School  for  Social  Workers  in 
Boston,  that  we  find  the  ideal  standing- 
ground  in  the  neighborly  relationship. 
When  neighbors  meet  in  country  villages, 
at  church  suppers,  tovv^n  meetings,  and 
cattle  shows,  we  have  friendly,  comfort- 
able, democratic  relations  between  many 
sorts  and  conditions  of  men,  Avithout  great 
intimacy,  but  equally  without  any  snob- 
bishness. 

Can  we  extend  this  neighborliness  to 
cover  the  relationsliip  between  a  profes- 
sional social  worker  and  those  in  need  of 
his  ad^dce?  I  tliink  not;  the  two  are  not 
neighbors  in  any  ordinary  sense.  They 
have  not  the  common  property-interests, 
common  acquaintances,  common  dealings 
in  town,  church,  and  club  affairs,  that 
make  the  stable  basis  of  true  neighborh- 
ness  and  furnish  topics  of  conversation. 
The  settlement  worker  may  persuade  him- 
self not  only  that  he  really  has  these  com- 


THE  ART  OF  HEALING  45 

mon  interests  with  liis  neighbors,  but  that 
this  fact  makes  the  basis  of  his  relation- 
ship to  them  more  natural  and  more  effect- 
ive than  that  of  any  other  social  workers. 
But  I  think  that  it  is  more  and  more 
agreed  that  valuable  as  settlement  work 
surely  is,  the  relationship  is  not  essentially 
that  of  neighbor  to  neighbor,  but  of 
teacher  to  pupil  or  pupil  to  teacher.  The 
settlement  worker  rarely  brings  up  his 
family  at  the  settlement,  and  in  his  rela- 
tions to  those  who  are  Hterally  his  neigh- 
bors he  is  more  hke  the  explorer,  or  the 
lighthouse  keeper.  He  is  not  there  for 
the  same  reason  that  any  of  the  people  in 
the  adjoining  houses  are  there,  any  more 
than  the  explorer  is  in  the  jungle  for  the 
same  reason  as  the  bushranger  and  the 
antelope. 

The  most  valuable  work  which  the  set- 
tlement worker  does  is  not,  I  think,  as 
neighbor  but  as  investigator,  teacher,  ex- 
pert interpreter,  and  referee.     Still  more 


46  SOCIAL  SERVICE  AND 

obviously,  but  no  more  genuinely,  is  this 
true  of  other  social  workers. 

To  fall  back  on  the  scriptural  usage  of 
the  words  "  my  neighbor  "  is  to  confuse 
the  issue,  for  that  phrase,  hke  "  friendh- 
ness,"  defines  everybody's  business  in  gen- 
eral and  not  the  social  worker's  in  particu- 
lar. Everyone  is,  in  the  scriptural  sense, 
the  neighbor  of  all  with  whom  he  is 
brought  into  contact.  But  everyone  is 
not  a  social  worker  either  in  fact  or  in 
ideal.  Neither  my  neighbor  in  space  nor 
my  neighbor  in  scripture,  nor  any  attempt 
to  fuse  the  two  meanings,  furnishes  the 
central  idea  of  social  work.  It  is  some- 
thing much  more  definite  than  this.  Yet 
we  see  in  the  attempts  to  tliink  of  the  social 
worker  first  as  a  friend  and  later  as  a 
neighbor  the  natural  and  proper  reaction 
against  the  aristocratic  and  patronizing 
idea  of  charity  alluded  to  at  the  begin- 
ning. 

The  "  Lady  Bountiful "  conception  of 


THE  ART  OF  HEALING  47 

charity  accented  unduly  and  perversely 
the  perfectly  true  fact  that  the  giver  is  in 
some  respect  the  superior  of  the  recipient. 
The  conception  of  social  work  as  a  rela- 
tionship between  friends  and  neighbors 
errs  equally  on  the  other  side,  for  it  sup- 
presses the  difference  and  proclaims  that 
the  unity  is  all  in  all.  Both  conceptions 
are  true,  both  one-sided.  What  can  unite 
them?    Modern  social  work  answers : 

The  conception  of  expert  service. 

(d)  Here,  I  think,  is  the  solution  of  the 
problem  of  distinctions  within  a  democ- 
racy. This  is  the  immortal  soul  of  the 
patronizing  conception  of  charity,  surviv- 
ing the  death  of  its  body.  Superiority 
there  is  and  ought  to  be,  but  superiority 
in  one  respect — the  obvious  superiority  of 
the  expert.  We  can  look  up  to  the  expert 
^ith  ready  acknowledgment  of  his  superi- 
ority. We  are  not  his  equal  here,  but  there 
is  not  a  particle  of  sense  of  shame  on  the 
one  side  or  of  condescension  on  the  other. 


48  SOCIAL  SERVICE  AND 

As  we  sit  by  the  stage  driver,  or  travel 
with  the  Adirondack  guide,  the  motorman, 
or  the  navigator,  our  relationship  is  per- 
fectly democratic  because  each  tacitly  ac- 
knowledges the  other  as  an  expert  in  his 
own  hne,  giving  and  receiving  respect, 
and,  if  there  is  opportunity,  exchanging 
information  such  as  to  strengthen  each 
other's  weak  points. 

This  is  the  nearest  approach  to  ideal 
democracy  outside  the  neighborhood  rela- 
tionsliip.  Whenever  the  neighborhood  re- 
lationship does  not  genuinely  exist,  this 
relationship  of  mutually  acknowledged  ex- 
perts is  the  best  alternative. 

A  third,  sKghtly  different  but  equally 
democratic  relationship  is  exemplified  in 
the  relationship  of  a  pubhc  school  teacher 
to  a  child  in  her  class,  or  of  a  physician 
to  some  of  the  more  ignorant  of  liis  pa- 
tients. Here  there  is  expert  knowledge  on 
one  side  and  none  on  the  other.  The  com- 
mon ground  of  meeting  is  the  common  in- 


THE  ART  OF  HEALING  49 

terest  in  the  subject  studied  or  in  the 
health  sought.  This  makes  something  ap- 
proaching a  neighborhood  relationship,  the 
essence  of  which  is  a  common  interest  in 
property,  in  business,  in  town,  church,  or 
club  affairs.  It  differs  from  the  neighbor- 
hood relation  in  that  the  meeting  ground 
is  in  thought  and  in  hope  instead  of  in 
the  neighborhood  interests.  Teacher  and 
pupil  are  both  interested  in  the  subjects 
studied;  doctor  and  patient  are  united  in 
the  pursuit  of  health.  On  these  grounds 
they  meet. 

There  are,  as  far  as  I  know,  no  satis- 
fying human  ties  except: 

(a)  Family  relationships  and  friend- 
ship; 

(b)  Neighborhood  relationships; 

(c)  Relationships  based  on  common  in- 
terests (financial,  scientific,  artistic,  ath- 
letic, etc.)  ; 

(d)  Relationships  between  experts, 
and 


60  SOCIAL  SERVICE  AND 

(e)  Relationships  of  the  teacher  and 
pupil  type. 

Now  the  social  worker  cannot  often  be 
a  professional  friend,  a  professional 
"  uncle "  or  "  aunty,"  a  professional 
neighbor,  or  a  professional  "  good  man.'' 
Nor  can  he  often  share  in  the  financial, 
artistic,  political,  or  scientific  interests  of 
his  client.  Hence  the  social  worker  must 
take  one  of  the  parts  that  are  left.  He 
must  hold  his  position  and  command  re- 
spect as  an  expert,  as  a  teacher,  or  as  a 
pupil. 

He  needs  all  the  virtues  no  more  and  no 
less  than  the  railroad  man,  the  farmer,  or 
the  shopkeeper.  But  his  first  and  chief 
duty  to  all  men  is  to  give,  with  such  ripen- 
ing sympathy  and  friendhness  as  is  pos- 
sible under  the  circumstances,  the  benefit 
of  his  expert  skill,  and  so  fulfill  his  special 
function  in  the  community. 

In  a  general  way,  I  think,  this  view  is 
coming  to  prevail.    The  social  worker  has 


THE  ART  OF  HEALING  51 

more  and  more,  in  the  last  decade,  come  to 
command  respect  and  salary  as  an  expert. 
People  are  beginning  to  take  this  view  of 
him,  and  with  the  change  come  the  new 
schools  for  social  workers,  which  plan  not 
only  to  inspire  their  members  with  social 
ardor,  but  to  give  them  the  professional 
knowledge  and  the  rigorous  training  nec- 
essary for  the  difficult  and  dehcate  task 
which  they  have  undertaken. 

But  this  attitude  is  new  and  not  yet  very 
stable.  The  social  worker  has  not  yet  won 
the  position  or  the  salary  that  he  deserves, 
because  the  pubHc  rightly  demands  that 
a  genuine  expert  shall  be  expert  in  some- 
thing in  particular;  if  we  are  to  acknowl- 
edge his  preeminence  we  must  have  some 
clear  idea  of  what  it  consists  in. 

We  are  told  by  Mr.  Edward  T.  De\dne 
that  many  topics,  many  sciences,  group 
themselves  about  the  study  of  philan- 
thropy. Pohtical  economy,  housekeeping, 
law,  medicine,  pubhc  hygiene,  architecture, 


52  SOCIAL  SERVICE  AND 

statistics,  the  humanities,  all  form,  he  says, 
more  or  less  important  auxiliaries.  But 
what  is  their  center?  Can  we  say  that  the 
general  purpose  to  do  good,  the  general 
aim  of  social  amelioration ^  is  definite 
enough  to  constitute  such  a  center?  I 
think  not.  For  that  should  be  everyone's 
business  and  no  one  profession  should 
have  a  monopoly  of  it.  It  is  too  all- 
inclusive. 

On  the  other  hand,  the  proper  adminis- 
tration or  withholding  of  financial  relief  is 
too  narrow,  for  social  workers  deal  with 
many  persons  who  are  not  dependent  and 
ask  for  no  rehef .  We  need  as  the  center 
and  focus  of  social  work  something  more 
comprehensive  than  rehef  but  less  vague 
than  charity  or  neighborhness  or  the  at- 
tempt to  serve  the  pubhc  good;  we  need 
a  center  around  which  we  can  group  the 
auxiHary  topics  and  sciences.  What  is 
that  center? 

A  comparison  with  medical  work  may 


THE  ART  OF  HEALING  53 

help  us  here.  The  physician,  Hke  the  social 
worker,  finds  it  necessary  to  master  the 
rudiments  of  many  sciences  in  wliich  he 
cannot  hope  to  become  an  expert.  He 
dips  into  chemistry,  optics,  physiology,  bi- 
ology, and  etliics,  but  he  does  not  merely 
organize  these  sciences  for  the  physical 
good  of  man.  He  arranges  them  about 
a  central  core  of  knowledge,  a  central 
science,  which  occupies  more  than  half  of 
all  his  training, — the  diagnosis  and  treat- 
ment of  disease.  It  is  only  in  this  field 
that  he  is  an  expert. 

Do  social  workers  possess  already  any 
such  central  body  of  knowledge  to  which 
all  the  rest  of  their  studies  contribute  ?  In 
point  of  fact  I  think  the  most  valuable 
social  workers  do  use  such  a  science  in 
practice,  though  rarely  in  clear  conscious- 
ness. But  it  seems  as  if  the  schools  of 
philanthropy  had  lagged  behind  the  work- 
ers, because  these  schools  conceive  their 
functions  to  be  fulfilled  by  teaching  a  httle 


54i  SOCIAL  SERVICE  AND 

of  the  auxiliary  sciences,  such  as  house- 
keeping, hygiene,  and  political  economy, 
while  spending  most  of  their  time  on  a 
bird's-eye  view  of  the  existing  agencies  and 
institutions  which  have  been  created  as 
remedies  for  the  difficulties  which  confront 
us. 

But  the  successful  social  worker  often 
knows  very  httle  of  political  economy, 
medicine,  and  the  rest.  He  differs  from 
the  rest  of  us  in  quite  other  respects.  An- 
other man  may  know  more  of  all  these  sci- 
ences than  the  social  worker  and  yet  be  a 
bungler  in  the  actual  craftsmansliip  of 
social  work.  He  may  have  a  good  work- 
ing knowledge  of  all  the  items  in  the  di- 
rectory of  charities,  of  all  the  existing 
agencies  for  the  cure  of  social  ills,  and  yet 
make  an  utter  mess  of  it  when  he  tries  to 
do  a  bit  of  probation  work  or  to  pull  up  a 
shiftless  family. 

This  (some  will  say)  is  because  he  has 
not  inherited  or  acquired  the  unteachable 


THE  ART  OF  HEALING  55 

tact,  the  actual  deftness  in  handling  cases 
which  the  successful  worker  possesses. 
He  must  first  be  born  to  it,  we  say,  and 
then  half -instinctively  find  out  the  rest  as 
he  gets  his  experience  in  the  work  itself. 
But  this  is  equally  true  of  the  diagnosis 
and  treatment  of  disease,  or  the  apprecia- 
tion and  interpretation  of  music.  The  doc- 
tor and  the  musician,  as  well  as  the  social 
worker,  must  be  born  for  his  profession, 
else  he  cannot  be  trained  for  it.  But  we 
do  train  him  despite  the  old  false  antith- 
esis, "born,  not  made." 

The  central  knack  and  talent  of  the  so- 
cial worker,  then,  is  not  economics,  or 
neighborhness,  or  a  general  desire  for  social 
amelioration,  nor  is  it  something  unteach- 
able.  The  essence  and  center  of  social 
work,  that  which  corresponds  to  diagnosis 
and  treatment  as  the  center  of  the  group 
of  medical  sciences,  I  may  venture  to 
phrase  as: 

The  study  of  character  under  adversity 


56  SOCIAL  SERVICE  AND 

and  of  the  influences  that  mold  it  for  good 
or  ill. 

This  is  the  genuinely  new  science  which 
it  is  the  business  of  our  best  social  students 
to  build  up  in  theory,  where  it  already  ex- 
ists more  or  less  concisely  and  satisfac- 
torily in  practice.  In  social  work  the  art 
has  preceded  the  science,  as  it  did  in  medi- 
cine and  music;  but  neither  science  nor 
art  can  live  well  without  the  other. 
The  science  must  back  and  direct  the 
art. 

In  support  of  this,  which  is  the  central 
thesis  of  this  chapter,  I  shall  adduce  two 
groups  of  arguments: 

First,  illustrations  of  the  fact  that  suc- 
cessful social  workers  are  now  engaged, 
for  the  most  part,  in  the  practice  of  this 
art,  the  diagnosis  and  treatment  of  char- 
acter under  adversity,  which  I  am  urging 
should  be  systematically  taught  in  schools 
of  philanthropy. 

Second,  reasons  for  believing  that  it  is 


THE  ART  OF  HEALING  57 

not  impossible  to  teach  this  science,  nor 
inconceivable  to  make  a  text-book  about  it. 

II 

Taking  up  the  first  of  the  above  theses, 
I  will  remind  you,  first  of  all,  of  the  wide, 
and  interesting  field  of  probation  work. 
When  I  first  became  a  director  of  the 
Boston  Children's  Aid  Society  and  began 
to  spend  time  with  the  paid  agents  of  the 
Society,  I  watched  them  in  their  advisory 
and  supervisory  work  with  children  and 
their  parents.  I  soon  became  aware  that 
I  was  witnessing  the  expert  practice  of 
the  art  of  character-study  and  character- 
molding.  Mr.  C.  W.  Birtwell,  Mr.  W.  H. 
Pear,  and  Mr.  S.  C.  Lawrence,  with  whom 
I  was  chiefly  associated,  w^ent  at  their  cases 
with  a  definite  diagnostic  method,  studied 
their  antecedents,  their  environment,  their 
present  characteristics,  their  strong  points, 
their  weak  points,  and  their  possibihties 
with  as  scientific  and  sure-footed  a  course 


5S  SOCIAL  SERVICE  AND 

of  procedure  in  their  mental  diagnosis  as 
the  physician  uses  in  liis  much  simpler 
physical  diagnosis. 

First  diagnosis,  then  treatment.  Know- 
ing the  cliild's  environment,  his  diet,  his 
play,  liis  school,  liis  parents,  liis  compan- 
ions, liis  amusements,  where  he  is  weak  and 
where  he  is  strong,  how  his  strength  and 
his  weakness  are  hnked,  and  where  these 
hnks  can  be  unfastened,  these  experts  in 
the  psychology  of  erring  cliildren  pro- 
ceeded to  choose  a  remedy  among  the  re- 
sources of  the  community.  They  used 
clubs,  churches,  country  families  for  plac- 
ing out,  personal  supervision  at  home,  the 
help  of  a  properly  assisted  and  directed 
parent,  studpng  and  judging  these  agen- 
cies of  the  envdronment  as  molders  of 
character,  i.e.,  as  spiritual  influences. 

Questions  of  financial  rehef  and  depend- 
ence are  here  quite  subordinate.  If  we 
define  the  vocation  of  the  social  worker 
as  the  diagnosis  and  treatment  of  financial 


THE  ART  OF  HEALING  59 

distress  (as  hr.s  been  suggested  to  me)  we 
should  have  to  say  that  such  probation 
work  was  not  social  work  at  all,  because 
it  is  in  most  cases  a  labor  of  education 
pure  and  simple.  What  is  the  weakness  in 
this  child's  character ;  how  can  it  be  helped? 
En^dronment  is,  of  course,  most  carefully 
studied,  but  not  only  the  physical  environ- 
ment. The  influences  about  the  child  and 
their  bearing  on  his  character  are  the  chief 
subjects  of  the  social  worker's  study  when 
he  has  made  his  diagnosis  and  turns  to 
treatment. 

Take  as  a  second  example  the  care  of 
the  girls  placed  out  from  a  large  reform 
school  like  that  at  Lancaster,  Mass.  Even  a 
slight  acquaintance  with  the  young  women 
who  are  in  charge  of  these  girls  makes 
one  at  once  aware  of  the  same  trained  man- 
agement of  character  based  on  the  skillful 
study  of  character  in  its  environment. 
Which  girl  is  in  trouble  because  of  excess 
of  vitahty,  and  which  because  of  moral 


60  SOCIAL  SERVICE  AND 

flabbiness,  deficient  vitality?  Which  one 
is  really  below  par  mentally,  which  is  in 
need  chiefly  of  encouragement  and  a 
healthy  spiritual  environment?  Char- 
acter is  always  the  central  problem,  the 
true  basis  both  of  classification  and  of  the 
choice  of  remedies.  To  classify  these  girls 
according  to  their  "  crimes  "  has  only  a 
very  hmited  value  and  cannot  be  used  as 
a  sufficient  basis  for  intelhgent  treatment. 

Here,  again,  there  is  often  no  question 
of  charity  or  of  financial  relief.  In  many 
if  not  most  of  these  cases  there  is  no  finan- 
cial or  economic  question  at  issue.  The 
problems  are  mental,  moral,  and  physical. 

Is  it  so  different  in  the  work  of  charity 
organizations  and  in  the  treatment  of  per- 
sons who  are  financially  dependent?  As 
I  watch  the  work  of  experts  in  this  field 
I  feel,  as  in  other  instances,  that  the  task 
is  chiefly  one  of  dehcate  and  difficult 
psychical  diagnosis  and  psychical  treat- 
ment.    To  the  expert  social  worker  an 


THE  ART  OF  HEALING  61 

application  for  reKef  comes  as  a  complaint 
of  pain  does  to  the  physician.  It  is  a 
symptom  of  deeper  defects.  Poverty  is  to 
social  work  as  pain  is  to  medical  work. 
It  may  or  may  not  need  treatment,  but 
thorough  diagnosis  is  the  first  necessity. 
To  find  out  whether  it  is  discourage- 
ment, overwork,  unforeseeable  misfortune, 
arrogance,  conceit,  forgetfulness,  un- 
imaginativeness,  congenital  degeneracy, 
alcoholism,  ignorance,  or  some  other  cause 
that  is  back  of  the  financial  breakdown, — 
tliis  is  what  I  see  these  experts  busy  about. 
Next  they  ask:  What  sound  hfe,  what 
untainted  character,  is  left,  and  what  is 
the  best  that  can  be  made  of  it?  What  in- 
fluences can  be  brought  to  bear  on  the 
paralyzed  will,  the  spasmodic  and  ungov- 
erned  energies,  the  darkened  and  narrowed 
mental  horizon?  Physical  and  financial 
diagnosis,  physical  and  financial  remedies 
are  always  useful,  but  always  subordinate 
to  the  central  problem,  which  is  more  like 


62  SOCIAL  SERVICE  AND 

a  problem  in  horticulture  than  one  in 
economics. 

Even  in  the  almshouse,  where  we  should 
be  dealing,  I  take  it,  chiefly  with  the 
wrecks  and  relics  of  character,  our  prob- 
lem is  still  how  to  make  the  most  and  best 
of  what  hf e  and  character  is  left ;  how  to 
prevent  it  from  degenerating  into  a  merely- 
brutal  or  vegetable  existence ;  how  to  make 
the  outlook  less  gloomy  and  desperate. 

Another  e\ddence  that  character  study 
is  beliind  most  if  not  all  of  the  common  re- 
hef  problems  appears  when  we  ask :  Why 
do  we  allow  many  widows  and  children, 
and  most  that  are  sick  or  aged,  to  be  de- 
pendent? Why  do  we  not  urge  them  all 
on  into  the  ranks  of  the  self-supporting? 
Some  children,  many  women,  and  a  certain 
number  of  sick  or  aged  men  are  doubtless 
the  better  for  earning  their  salt ;  others  are 
not.  The  principle  of  decision,  which 
seems  to  be  recognized  by  expert  social 
workers,  is  this:  What  is  best  for  the  in- 


THE  ART  OF  HEALING  63 

dividual's  development  and  for  the  com- 
munity? It  is  not  good  for  the  mental 
and  moral  life  of  most  healthy  adults  to 
be  dependent  financially  or  in  any  other 
way.  Whenever  we  find  exceptions  to  this 
rule  they  must  be  made  because  we  beheve 
it  best  for  the  character  of  the  individuals 
and  of  the  community  in  which  they  hve 
that  they  should  be  financially  dependent 
in  order  that  they  may  put  forth  their  full 
powers  in  ways  not  now  remunerative ;  for 
example,  in  getting  educated  or  getting 
well.  But  some  children,  some  sick,  and 
some  old  people  ought  nevertheless  to 
work  for  a  Hving.  Why?  Because  they 
need  it  to  keep  their  souls  alive,  and  be- 
cause nothing  else  will  do  this  as  far  as  we 
know.  Our  campaign  is  not  against  all 
poverty  and  distress  but  against  such  pov- 
erty and  distress  as  cramp  the  normal  de- 
velopment of  character. 

The  fact  that  dependence  and  relief  are 
usually,  but  not  always,  undesirable  in  the 


e4i  SOCIAL  SERVICE  AND 

healthy  adult,  that  they  are  more  often 
desirable  in  children  under  sixteen  and  in 
the  sick,  wliile  in  adolescence  dependence 
is  sometimes  good  and  sometimes  bad, 
shows  that  even  in  that  portion  of  social 
work  that  deals  A\ith  relief  problems,  the 
underlying  question,  in  many  if  not  in 
most  cases,  must  be  still:  What  is  the 
structure  and  need,  the  strength  and  weak- 
ness, of  these  persons  before  us,  and  what 
is  the  effect  on  them  and  on  the  community 
of  the  dependence  which  we  propose  to 
create  or  to  abohsh? 

I  have  now  considered  the  psychical 
factor  in  social  work  as  exemphfied  in  the 
case  of  misbeha^dng  cliildren,  adolescents, 
and  adult  dependents.  In  the  charities 
aiding  unmarried  mothers,  the  bhnd,  the 
feeble-minded,  in  the  training  of  social 
secretaries,  welfare  w^orkers,  settlement 
workers,  prison  officials,  home  and  school 
visitors,  school  nurses,  factory  nurses, 
tuberculosis  nurses,  and  workers  in  church 


THE  ART  OF  HEALING  65 

clubs,  it  is  even  more  ob\dous  that  not  reKef 
but  the  analysis  and  understanding  of 
character  under  adversity,  and  of  the 
means  of  developing  it,  are  the  main  things 
to  be  learned. 

I  will  rest  at  this  point  my  case  for  the 
thesis  that  the  true  business  of  the  social 
worker  is  psychical  diagnosis  and  treat- 
ment, a  labor  parallel  to  that  of  the  physi- 
cal diagnosis  and  treatment  of  the  physi- 
cian. 

Ill 

But  now,  granting  that  this  is  the  sort 
of  wisdom  to  be  desired  and  striven  for, 
is  it  possible  to  teach  it?  What  has  been 
done  thus  far  towards  reducing  it  to  teach- 
able, that  is,  to  scientific  form? 

Character  and  the  influences  molding 
it, — this  is  the  subject  of  our  inquiry. 
The  studies  relating  to  it  can  be  arranged 
in  two  groups : 

1.  The  researches  of  Jacob  Riis,  Helen 


66  SOCIAL  SERVICE  AND 

Bosanquet,  Jane  Addams,  Robert  Woods, 
and  others,  into  the  psychology  of  the 
hard-pressed.  Put  a  newly-arrived  immi- 
grant into  a  crowded  tenement  house  dis- 
trict among  races  and  customs  foreign  to 
him — what  results?  The  outcome  of  this 
huge  laboratory  experiment  is  reported 
in  such  books  as  Jane  Addams's  "  Newer 
Ideals  of  Peace,"  Riis's  "  How  the  Other 
Half  Lives,"  Woods's  "  The  City  Wilder- 
ness "  and  "  Americans  in  Progress." 

Put  a  relatively  homogeneous  race  into 
the  crowded  capital  of  a  small  and  crowded 
island,  squeeze  it  between  the  upper  and 
nether  millstones  of  poverty  and  drink: 
what  type  of  character  results?  Mrs. 
Bosanquet  has  answered  the  question  in  a 
series  of  searching  and  skillful  studies.^ 

Charles  Booth's  monumental  survey  of 
London  conditions  ("  Life  and  Labor  in 
London";  8  volumes)  and  especially  the 

^"The   Family,"   "Rich   and   Poor,"   "The   Standard 
of  Life,"  "The  Strength  of  the  People." 


THE  ART  OF  HEALING  67 

recent  "  Pittsburg  Survey  "  are  concerned 
throughout  with  the  bearing  of  physical 
and  economic  conditions  on  character, 
though  the  connection  is  not  always  thor- 
oughly worked  out. 

2.  The  second  group  of  studies  is  less 
generally  known  to  social  workers  them- 
selves and  has  been  carried  on  for  the 
most  part  by  their  cousins  the  educators. 
I  refer  to  the  child-study  researches.  Like 
the  last  group,  these  investigations  deal 
with  character  in  its  environment,  but  here 
the  emphasis  is  on  character — there,  on  en- 
vironment. These  character-studies  are 
supposedly  concerned  with  normal  chil- 
dren, but  as  all.  cliildren  are  more  or  less 
faulty,  the  distinction  from  those  who  come 
into  the  field  of  the  social  worker  is  not  a 
sharp  one.  Indeed,  the  distinction  be- 
tween the  vocation  of  the  educator  and 
that  of  the  social  worker  should  be  merely 
one  of  convenience. 

Without  trying  to  sum  up  in  any  way 


68  SOCIAL  SERVICE  AND 

the  work  of  the  child-study  researches,  I 
have  selected  two  interesting  items  in  illus- 
tration of  the  sort  of  study  which  I  hope 
to  see  much  furthered  in  schools  for  social 
workers. 

Joseph  Lee  ^  has  made  a  striking  effort 
to  found  a  character-study  of  children,  by 
dividing  them  into  three  ages,  with  special 
reference  to  play: 

(a)  The  "  dramatic "  age,  when  the 
child  is  fond  of  plays  of  make-believe; 

(b)  The  "  Big-Injun "  period,  when 
he  is  prone  to  individualistic,  reahstic  oc- 
cupations ; 

(c)  The  "  age  of  loyalty,"  when  team- 
work becomes  possible. 

Professor  Josiah  Royce,  of  Harvard 
University,  gave  some  years  ago  a  course 
of  lectures  on  the  character  of  children,  lec- 
tures containing  a  few  references  to  chil- 
dren's faults  and  their  management. 
After  each  lecture  he  was  bombarded  with 

^Joseph  Lee:  Educational  Review.    December,  1900. 


THE  ART  OF  HEALING  69 

interesting  questions  from  anxious  moth- 
ers and  teachers,  who  were  hungry  for 
such  crumbs  of  a  science  of  the  diagnosis 
and  treatment  of  children's  faults  as  were 
dropped  in  a  course  of  lectures  not  con- 
cerned primarily  with  these  questions. 

The  attempted  classification  at  the  Lan- 
caster Reform  School  for  girls  by  the  char- 
acteristics supposed  to  lead  to  the  crime 
rather  than  by  the  crime  itself  is  another 
straw  floating  on  the  same  current.  I  will 
merely  mention  also  Mrs.  Bosanquet's  ^ 
studies  in  the  mental  characteristics  of  the 
shiftless,  and  President  Hadley's  ^  division 
of  the  college  students  into  men  of  action, 
men  of  hterary  interests  (artistic),  and 
men  of  science. 

These  disjointed  scraps  and  sugges- 
tions are,  of  course,  no  proof  that  a  science 
of  character-study  and  character-molding 

*  Helen  Bosanquet:  "Aspects  of  the  Social  Problem," 
page  83. 

^A.  T.  Hadley:  Harper's  Magazine,  June,  1905. 


70  SOCIAI.  SERVICE  AND 

exists.  The  art  exists,  but  the  science  has 
not  yet  gotten  very  far.  I  have  often 
longed  to  have  the  opportunity  to  tran- 
scribe, hke  some  sort  of  a  Boswell,  the  wis- 
dom, the  science,  which  I  know  is  stored  in 
the  minds  and  active  in  the  habits  of  our 
most  skillful  social  workers  but  is  nowhere 
in  print.  When  these  experts  die  much 
T^dsdom  will  die  ^^dth  them.  There  is, 
however,  especially  in  France,  some  scien- 
tific work  on  this  matter,  work  with  which 
I  tliink  social  workers  should  be  more  fa- 
miliar. 

Social  workers  have  already  begun  to  get 
in  touch  mth  psychotherapeutic  hterature 
on  the  one  hand  and  with  psychodiagnostic 
hteratm-e  on  the  other.  But  the  acquaint- 
ance should  ripen  into  intimacy.  Social 
workers  are  constantly  confronted  mth  the 
problem  of  training  the  will,  but  how  many 
of  them  have  ever  seen  J.  Payot's  book 
on  the  "  Education  of  the  Will,"  or  Levy's 
monograph  on  the  same  subject,  or  even 


THE  ART  OF  HEALING  71 

Dubois's  "  Psychic  Treatment  of  Nerv- 
ous Disease  "?  These  books  are  not  ex- 
hortations or  theoretical  analyses.  They 
are  the  works  of  men  who  have  been  train- 
ing wills, — ^more  or  less  diseased  and 
broken  wills, — and  report  their  methods 
and  the  degree  of  success  that  can  be  rea- 
sonably expected. 

We  all  agree  that  the  treatment  of  cases 
as  they  come  to  us  must  not  be  mechanical 
or  routine.  If  we  are  to  avoid  tliis  we 
must  distinguish  the  types  of  character 
with  which  we  are  concerned  and  adapt 
our  methods  accordingly.  But  do  social 
workers  ever  read  Fouillee's  "  Tempera- 
ment and  Character, — Their  Variations 
According  to  Race,  Sex,  and  Individual- 
ity," ^  or  Levy's  "  Psychology  of  Char- 
acter," or  Paulhan's  works  on  the  same 
subject?  As  a  matter  of  fact,  I  think  so- 
cial workers  can  write  books  far  better 
than  these.    They  are  more  closely  in  touch 

^  Paris  (Alcan),  108  Boulevard  St.  Germain,  1895. 


72  SOCIAL  SERVICE  AND 

-^nth  the  facts.  They  treat  more  cases  than 
these  writers  do.  Yet  these  books  will 
be  found  stimulating,  unless  I  am  very 
much  mistaken.  The  social  worker  can 
verify  what  is  true,  reject  the  rest,  and 
work  out  to  their  fulfillment  the  good  in- 
tentions of  these  scholars. 

3Ieantime,  in  order  to  afford  a  basis  for 
criticism,  and  to  make  a  little  more  con- 
crete the  rather  vague  suggestions  so  far 
presented,  I  shall  try  to  imagine  the  chap- 
ter headings  or  table  of  contents  of  the 
epoch-making  book  on  character-study 
wiiich  an  expert  social  worker  will  some 
day  ^^Tite  out  of  the  abundance  of  liis 
knowledge. 

AN  OUTLINE  STUDY  OF  CHAEACTEE 

I.    The  Physiology  of  Character 

(1)  The  more  or  less  subcon^  f  ^ 'f  flothes  ^ '  "'sheUerV 
scions  seeking  of  the  primal  {  (ciotnes,  siielter), 
n,«r/?**ifj^.*     ^     /  ^  food,   water,   procre- 


l     ation. 


THE  ART  OF  HEALING  73 

(2)  The  Fundamental  Their 

Conscious   Tendencies        and         Outlets 

,  ^   -r        ..     ..  (  Scientific  Interests. 

(a)  Investigation    |  Philosophy. 

{Exploration,  sub  j  uga- 
tion,  hunting,  ex- 
ploitation. 

(b)  Conquest.} 

iWar,  politics,  diplo- 
macy,  business, 
athletics. 

(c)  Creation,      construction,    j  Art,   literature,   games, 
play (      government,  accumu- 
lation. 

Family  and  friendly 
relations,  nursing, 
social  work,  part  of 
medicine,  education, 
care  of  plants  and 
animals. 


(d)  Nurturing 


(3)     The     differentiations     and     admixtures     of     these 
tendencies  according  to: 
...  j  Childhood,   adolescence,   ma- 

v^^  -^Se  ^  turity,  old  age. 

(b)  Sex 

(c)  Race  i  ^^    *^^^    country    especially 
^  '  (      Irish,  Jew,   and   Italian. 

(d)  Climate  and  Resi-    (  City,  suburbs,  open  country, 

dence  (  seashore,  mountains. 

(e)  Occupation 

(  Rich 

(f)  Economic  Status       -J  Poor 

(  Comfortable. 

(g)  Social  environment  j  ^j^'^^J.'  g^"^'  ^IV^' 
^^'  (  Irmtation,  Reaction. 

i.e.,    the   portion    left    after 
(h)  Education  excluding    the    above    in- 

fluences. 


74  SOCLAX  SERVICE  AND 

II.     Pathology  of  Character 

(1)   Exaggerations,   deficiencies,   and   perversions   of   the 
tendencies  above  described   (congenital,  acquired). 

{2)  Paroxysmal     and      impulsive      outbreaks;     temper, 
tramping,    drinking,    sexuality. 

(3)  Dissociations,     i.e.,      forgetfulness,     tangent-taking, 

panic-states,  cowardice,  dissipation. 

(4)  Degenerations,  atrophies,  formation  of  fixed,  stereo- 

typed  habits. 

III.     Causes  of  Special  Faults 

TV.     Progxosis 

The  outlook  for  various  faults,  as  judged  hj  statistics 
of  eases  under  standard  treatment. 

V.     Treatment 

^Methods,  agencies,  laws,  institutions,  for  the  preven- 
tion, modification,  alleviation,  or  cure  of  the  faults  above 
described. 

At  present  oiilj^  No.  3c  and  ISTo.  V  of 

tliis  outline  are  taught  to  any  extent  in 
schools  for  social  workers.  Until  text- 
books are  gradually  built  up  through  sys- 
tematic research  and  the  statistical  study 
of  records,  the  principle  of  character-study 
and  character-molding  ^^dll  have  to  be 
learned  as  it  has  been  so  far,  ^^dthout  books 
or  lectures,  but  largely: — 

(a)  By  watcliing  the  work  of  experts. 

(b)  By    studying    under    supendsion 
carefully  recorded  reports  of  illustrative 


THE  ART  OF  HEALING  75 

cases.  (The  effort  to  select  these  would 
make  of  itself  a  tentative  classification  or 
grouping,  which  is  the  beginning  of  a 
science. ) 

(c)  By  practicing  under  careful  super- 
vision the  actual  diagnosis  (investigation) 
and  treatment  (disposal)  of  cases. 

I  see  no  reason  to  doubt  that,  in  the 
science  and  art  of  character-study  and 
character-molding,  books  will  ultimately 
come  to  occupy  the  same  useful  position 
as  in  medicine,  though  as  educative  influ- 
ences they  will  always  be  subordinate  (as 
they  are  in  medicine)  to  the  watching  of 
experts  at  work,  the  subsequent  or  pre- 
liminary analysis  and  discussion  of  printed 
cases,  and  the  later  apprenticeship  in  the 
work  itself. 

rv 

The  need  for  a  clearer  recognition  of 
the  new  science  and  center  of  social  work 
may  be  brought  out  in  some  other  ways. 


76  SOCIAL  SERVICE  AND 

The  organizers  of  conferences  and  of 
schools  for  social  workers  find  it  hard  to 
decide  what  to  include  and  what  to  ex- 
clude. Programmes  contain  each  year  more 
and  more.  What  shall  determine  their 
limits  ?  I  should  answer,  Whatever  brings 
new  grist  to  the  mill  of  character-study 
and  character-molding.  Play,  for  exam- 
ple, is  surely  an  essential  element  in  the 
expression  and  formation  of  children's 
character.  Social  workers  should  study 
play,  playgrounds,  and  play-apparatus, 
especially  with  reference  to  their  value  in 
the  development  of  normal  and  the  pre- 
vention of  faulty  character.  Their 
physical  aspect,  their  economic  and 
municipal  aspect  is  a  matter  primarily 
for  others. 

In  a  striking  and  important  paper 
printed  about  three  years  ago  in  Charities  ^ 
Lee  K.  Frankel  analyzed  the  cases  of  one 
hundred  persons  applying  to  a  New  York 

^  Charities,  November  17,  1906. 


THE  ART  OF  HEALING  77 

charitable  organization  for  relief,  and  stu- 
died the  causes  leading  to  the  application. 
He  found  practically  no  moral  or  mental 
deficiency,  no  fault  or  warping  of  char- 
acter. The  trouble  he  concludes  is  due  to 
the  conditions,  the  environment  in  whicli 
these  people  were  forced  to  live.  Ap- 
parently then  there  is  nothing  here  for  the 
social  worker,  if  I  am  right  in  describing 
him  as  a  student  and  physician  of  charac- 
ter. Do  not  his  figures  wholly  refute  my 
thesis  ? 

Let  us  look  again  at  his  figures.  In 
sixty-two,  or  practically  two-thirds  of  all 
his  cases,  the  destitution  was  due  to  illness. 
But  it  was  the  business  of  the  physician  to 
have  prevented  that  illness  through  the 
pubhc  health  authorities,  or  to  have  treated 
it  when  it  occurred.  It  is  true  that  physi- 
cians do  not  now  prevent  or  properly  treat 
such  cases;  but  that  does  not  mean  that 
the  social  workers  should,  except  tempo- 
rarily, take  charge  of  them.     Social  work- 


78  SOCLAX  SERATCE  AND 

ers  must  study  the  effects  of  diseases  (e.g., 
malnutrition  '  upon  character,  and  then  do 

all  they  can  to  make  the  pubhc  aware  of 
the  harm  that  is  being  done,  the  waste 
wliich  should  be  stopped.  Social  workers 
must  I  :rce  upon  physicians  and  Health 
Boards  the  full  weight  of  their  responsi- 
bility for  the  pubhc  health. 

In  the  remaining  one-tliird  of  Mr. 
Frankehs  cases  the  trouble  seemed  to  be 
due  cliierly  to  insufficient  wages.  But 
-:c:al  workers  cannot  do  much  to  raise 
wages.  That  is  the  business  of  the  capi- 
talist and  of  labor,  organized  or  unorgan- 
ized. Sickness  and  low  wages  it  is  rarely 
the  social  worker's  business  to  cure.  With 
environ  me  lit  in  its  effects  on  character  he 
must  constantli^  deal,  but  rarely  ^^ith  the 
great  physical  or  economic  forces  chat 
produce  the  troubles  such  as  Mr.  Frankel 
brings  to  our  notice.  I  T^ish  especially  to 
emphasize  my  appreciation  of  the  fact  that 
because  the  social  worker's  ciiief  business 


THE  ART  OF  HEALING  79 

is  with  character,  and  because  his  training 
should  be  so  shaped  as  to  help  him  deal 
skillfully  and  appreciatively  with  charac- 
ter,— for  these  reasons  he  must  be  con- 
stantly studying  en\dronment.  Anyone 
who  studies  character  knows  how  deeply 
it  is  made,  molded,  or  marred  by  con- 
ditions. 

But  he  will  study  conditions  not  pri- 
marily in  their  bearing  on  health,  as  the 
physician  should;  not  on  earning  power, 
which  is  the  business  of  the  captains  of 
labor,  who  bend  their  energies  to  see  how 
this  environment  can  be  made  more  pro- 
ductive. The  social  worker  should  study 
the  effect  of  city  life,  of  hfe  on  the  plains, 
of  noise,  dirt,  vice,  child-labor,  long  hours, 
not  only  in  their  effect  on  health  or  in- 
come, but  especially  in  their  effect  on 
character.  Hygienically  it  is  often  imma- 
terial whether  a  room  or  a  person  is 
clean,  but  morally  it  may  make  a  crucial 
difference. 


80  SOCIAL  SERVICE  AND 

Tuberculosis  is  a  matter  of  great  im- 
portance both  in  relation  to  public  health 
and  in  relation  to  the  exhaustion  of  savings 
with  the  production  of  dependency ;  but  it 
is  also  and  chiefly  important  to  the  social 
worker  by  reason  of  the  effect  which  tuber- 
culosis and  its  treatment  may  have  on  the 
character  of  the  sufferer  and  of  his  family. 
Just  here  I  tliink  the  social  workers  have 
been  somewhat  misled  by  the  enthusiasm 
and  vigor  of  the  present  pubhc  interest  in 
the  crusade  against  tuberculosis.  The 
suppression  of  tuberculosis  is  the  business 
of  doctors  and  public  health  officials.  The 
doctors  have  been  remiss  in  this  matter. 
It  needed  the  pressure  of  the  general  pub- 
lic and  of  the  social  workers,  spokesmen 
for  the  public,  to  stir  the  doctors  to  the 
proper  reahzation  of  their  duty,  but  here 
I  think  the  duty  of  the  social  worker 
should  cease.  He  should  not  give  upon 
the  programmes  of  his  conferences  so 
much  space  to  those  aspects  of  the  mat- 


THE  ART  OF  HEALING  81 

ter  which  are  primarily  the  physicians' 
business. 

On  the  other  hand,  I  hope  to  see  social 
workers  devote  more  research  and  energy 
to  the  study  of  how  to  prevent  the  doctors 
from  hurting  the  souls  of  their  tuberculous 
patients  while  busy  in  the  attempt  to  have 
them  live  by  bread  (with  milk  and  eggs) 
alone.  The  importance  of  properly  chosen 
work  for  the  tuberculous  patient  in  differ- 
ent stages  of  the  disease  has,  I  think,  been 
greatly  underestimated.  The  doctor's  at- 
tention is  directed  elsewhere.  It  should 
be  the  special  business  of  the  social  worker 
to  point  out  that,  not  for  economic  but  for 
spiritual  reasons,  it  is  a  dangerous  experi- 
ment to  take  a  man  away  from  his  work 
and  put  him  on  his  back  in  a  steamer-chair 
for  months  at  a  time. 

Had  the  social  worker  thought  of  his 
business  not  as  primarily  either  physical 
or  financial,  nor  as  that  of  a  worker  for 
the  public  good  in  general,  but  specifically 


82  SOCIAL  SERVICE  AND 

as  that  of  guarding,  building,  and  develop- 
ing character,  tliis  mistake  might  have  been 
more  generally  recognized  and  avoided. 

Social  workers  must  not  labor  prima- 
rily over  the  physical  aspects  of  tubercu- 
losis, playgrounds,  tenement  houses,  pris- 
ons, garment-workers!  Who  \\ill  watch 
over  the  psycliical  aspects  of  every  such 
bit  of  social  macliinery  unless  the  social 
worker  is  awake  to  this  responsibility? 
The  doctor,  the  legislator,  the  economist, 
the  school  teacher,  each  faces  a  shghtly 
different  problem.  No  one  but  the  social 
worker  is  set  to  watch  the  spiritual  effect 
of  these  agencies.  There  is  danger  that 
he  may  not  be  duly  watchful  at  the  post. 

The  social  worker,  hke  the  teacher, 
should  be  cliieily  an  educator,  nurturer, 
stimulator,  developer,  and  director  of  hu- 
man souls,  particularly  in  that  group  of 
persons  whose  character,  temperament,  or 
en^dronment  has  brought  them  into  some 
sort  of  trouble. 


THE  ART  OF  HEALING  83 

He  is  an  educator;  a  school  of  philan- 
thropy is  a  normal  school;  but  we  must 
avoid  thinking  of  the  subject-matter  in 
this  sort  of  normal  school  as  the  survey 
of  the  resources,  such  as  almshouses,  pris- 
ons, playgrounds,  probation,  etc.,  which 
have  already  been  found  useful  in  his  spe- 
cial branch  of  education.  The  educator 
knows  that  his  subject-matter  is  never,  at 
bottom,  a  subject  like  geography  or  his- 
tory, but  always  the  child's  soul,  and  such 
product  of  other  people's  souls  as  may 
serve  to  develop  it.  For  fear  of  seeming 
to  lack  a  sense  of  humor,  the  educator  can 
hardly  yet  say  this  to  the  pubhc,  but  he 
knows  that  it  is  true  and  in  "  family 
gatherings  "  he  admits  it.  So  must  the 
social  worker.  There  is  no  more  arro- 
gance in  the  admission  for  him  than  for 
the  teacher.  For  is  it  not  really  true  that 
the  science  of  social  work  is  not  any  rem- 
edy hke  relief,  or  placing  out,  or  alms- 
houses, but  primarily  the  nature  and  type 


84.  SOCIAL  SERVICE  AND 

of  warped,  pinched  or  faulty  human  souls, 
and  secondarily,  the  psychical  effects  of 
the  social  remedies  which  have  been 
worked  out  experimentally  in  the  past? 

The  medical  student  does  not  begin  with 
the  study  of  drugs,  but  with  anatomy  and 
physiology  as  aids  to  diagnosis.  He  is 
not  primarily  concerned  with  theories  of 
cure.  No  more  should  the  student  of 
social  work  be  concerned  primarily  with 
a  bird's-eye  view  of  the  existing  ^charitable 
and  reformatory  resources  of  the  commu- 
nity, nor  with  the  reforms  proposed  and 
laws  enacted  for  the  cure  of  social  ills. 
For  this  is  to  learn  treatment  before 
diagnosis. 


It  is  true  enough  that  you  cannot  de- 
velop a  man's  character  successfully  nor 
appeal  effectively  to  the  best  that  is  in  him 
if  all  the  while  someone  else  is  sitting  on 
his  head.     You  can't  train  and  strengthen 


THE  ART  OF  HEALING  85 

moral  fiber  if  the  physical  tissues  are  half 
starved  and  the  brain  deadened  by  over- 
work, alcohol,  or  loss  of  sleep.  Unless  the 
social  worker  can  get  someone  else  to 
remedy  these  conditions  liis  work  is  useless. 
It  is  not  his  business  to  treat  alcohohsm 
or  to  shut  up  breweries,  to  do  pohce  work 
or  nurse's  work,  nor  to  feed  school  chil- 
dren. He  may  be  forced  in  emergencies 
to  pitch  into  any  of  these  occupations  as 
any  citizen  will  jump  into  the  fire  brigade 
when  forest  fires  threaten  a  town.  But 
this  is  not  his  regular  job.  He  may — nay, 
he  must  do  all  in  his  power  to  rouse 
the  properly  constituted  authorities  when 
cliild-labor,  disease,  or  lack  of  employment 
balks  his  work.  But  he  cannot  be  a  busy- 
body, a  jack  of  all  trades  or  a  "  supporter 
of  all  good  causes  "  if  he  is  to  command 
respect  as  an  expert  in  his  own  field. 

If  the  social  worker  occupies  himself 
with  improving  the  public  schools,  the 
conditions  of  employment,  the  law  courts, 


86  SOCIAL  SERVICE  AND 

the  hospitals,  the  condition  of  the  streets 
and  tenement  houses  (as  he  has  recently 
been  advised  to  do  by  the  editor  of  Chari- 
ties and  the  Commons) ,  will  he  not  de- 
serve to  be  asked  whether  he  has  no  busi- 
ness of  his  own  to  attend  to?  No  man 
can  understand  so  many  subjects. 

But  he  can  understand  a  single  (for  him 
an  all-important)  aspect  of  these  intricate 
subjects;  \dz.,  their  bearing  on  character. 
The  doctor  cannot  know  much  about  elec- 
tricity;— its  effect  on  human  health  is  the 
one  tiling  he  has  time  to  understand.  So 
the  social  worker  cannot  pass  judgment 
on  hospital  management.  But  he  must 
be  keen  to  understand  (and  if  possible  to 
neutralize)  the  harm  done  to  a  family 
when  a  ^vife  goes  to  a  hospital  for  some 
weeks,  and  thereby  deprives  her  husband 
and  her  daughters  of  the  moral  support 
wliich  has  liitherto  kept  them  in  the 
straight  path. 

Shall  the  social  worker  effect  no  radical 


THE  ART  OF  HEALING  87 

reform,  no  removal  of  those  conditions 
(poverty,  drink,  ignorance,  disease,  over- 
work, overcrowding)  which  undermine 
and  vitiate  character?  Must  he  confine 
himself  to  case  work,  to  palliation,  to 
patching  up  the  broken  characters?  The 
answer  seems  to  me  this: 

If  he  is  wise  enough  materially  to  dimin- 
ish poverty  and  overwork  he  is  the  wisest 
statesman  hving  and  his  work  should  be 
in  statecraft,  legislation,  and  economic  re- 
construction. There  cannot  be  many  such 
prophets  in  any  century — far  too  few  to 
constitute  a  profession.  The  diminution 
of  ignorance  and  disease  is  the  work  of 
the  educator  and  the  physician  through 
centuries  of  endeavor, — not  a  reform  to 
be  won  at  a  stroke  by  anyone. 

Every  profession  must  work  primarily 
with  individuals — the  social  worker  as  well 
as  the  rest.  Every  profession  will  also 
try  to  effect  through  education,  through 
public  opinion,  through  legislation  the  re- 


88  SOCIAL  SERVICE  AND 

moval  of  the  obstacles  in  the  way  of  its 
work.  Each  will  call  the  rest  to  account 
when  their  failures  block  liis  path.  But 
none  wants  to  earn  the  title  of  walking 
delegate  or  professional  reformer. 

Does  not  the  social  worker  deal  con- 
stantly in  his  work  mth  characters  far 
finer  than  his  own,  \dctims  of  misfortune 
and  not  of  their  own  fault?  Surely  he 
does;  and  he  is  then  the  pupil,  not  the 
teacher.  Social  work  is  still  going  on,  but 
the  positions  are  reversed. 

In  other  cases  there  need  be  no  more 
sense  of  superiority  than  the  butcher  feels 
when  he  sells  us  meat.  He  has  more  than 
we,  but  he  too  needs  it  and  eats  it  himself. 
So  the  social  worker,  like  the  school 
teacher,  shares  with  others  the  knowledge 
or  the  enthusiasm  by  w^hich  he  himself  is 
guided, — on  which  he  depends.  He  gives 
advice,  he  shares  experience,  he  helps  to 
make  plans  simply  because  he  has  been 
in    such    scrapes    before,    not    because 


THE  ART  OF  HEALING  89 

he     arrogates     any     especial     merit     to 
himself. 

VI 

Once  thoroughly  equipped  and  recog- 
nized as  an  expert  in  the  understanding 
and  management  of  the  weaknesses  and 
perversions  of  character,  the  social  worker 
should  command  expert  fees.  He  should 
have  his  office  hours  and  his  private  prac- 
tice as  well  as  his  public  work  among  the 
poor.  He  should  be  consulted  as  Mark 
Fagan  used  to  be  consulted,  as  Professor 
Royce  is  often  consulted,  by  rich  and  poor, 
in  all  sorts  of  moral  and  domestic  diffi- 
culties, by  the  parents  of  difficult  children, 
by  the  children  of  difficult  parents,  and 
also  by  many  neurasthenics  seen  in  con- 
sultation with  physicians.  The  average 
social  worker  is,  in  my  opinion,  far  better 
equipped  to  treat  neurasthenia  than  the 
average  physician  is.  The  mental  and 
moral   aspects   of  such  cases   altogether 


90  SOCIAL  SERVICE 

overshadow  their  physical  aspects,  and  the 
problems  of  occupation,  of  encourage- 
ment, of  foresight,  hindsight,  and  of  re- 
sponsible living  are  just  what  the  social 
worker  is  constantly  encountering. 

I  see  no  reason  why  social  work  should 
be  done  chiefly  among  the  poor.  My  most 
intimate  and  thorough  knowledge  of  the 
topic  has  been  gained  through  the  social 
work  done  by  my  wife  on  me.  Social 
work  (the  understanding  and  molding  of 
faulty  character)  is  possible,  I  know,  be- 
cause I  have  experienced  it  in  the  hands 
of  an  expert. 


CHAPTER  III 

TEAM-WORK  OF  DOCTOR,  EDUCATOR,  AND 
SOCIAL  WORKER^  AND  THE  RESULTING 
CHANGES  IN  THE  THREE  PROFESSIONS — 
A  REVIEW  AND  A  PROGRAMME 

Despite  the  distinctions  emphasized  in 
the  last  chapter,  history  shows  that  medi- 
cal work  and  social  work  are  branches 
split  off  from  a  common  trunk: — the  care 
of  people  in  trouble.  In  earher  centuries 
the  priest  healed  the  sick,  cared  for  the 
poor,  taught  the  ignorant,  and  often  led 
his  people  in  industrial,  governmental,  and 
even  in  martial  activities.  He  was  the  law- 
giver and  magistrate,  the  doctor,  the 
school-teacher,  the  dispenser  of  charity, 
the  temporal  ruler,  and  sometimes  the 
leader  in  war.  Such  all-inclusive  useful- 
ness in  the  priesthood  still  hngers  here  and 

91 


92  SOCIAL  SERVICE  AND 

there  among  us.  Father  Xisco  in  the  little 
town  of  Roseto,  Penn.  (see  McClure's 
Magazine,  January,  1908) ,  is  doing  some- 
thing very  hke  this  now.  He  is  the  leader 
of  his  town  in  industrial,  municipal,  and 
political  life  as  well  as  in  educational  and 
spiritual  affairs. 

In  a  similar  way,  the  country  doctor, 
the  old-fashioned  family  physician,  has 
sometimes  extended  his  profession  as 
widely  and  deeply  as  the  priest  was  once 
allowed  to  do.  Barrie  and  Watson  have 
described  such  doctors  and  many  of  us 
have  known  them,  leaders  in  all  civic  work. 

But  specialization  of  work  and  division 
of  labor  have  come  into  the  field  once  occu- 
pied alone  by  the  minister  or  the  doctor. 
The  doctor  is  now  supposed  to  care  for  the 
diseased  body,  the  teacher  for  the  unde- 
veloped mind,  the  minister  for  the  needy 
soul,  the  social  worker  for  the  poor,  while 
justice  and  governmental  work  are  hke- 
wise    intrusted    to    speciahsts.     On    the 


THE  ART  OF  HEALING  93 

whole,  doubtless,  this  division  of  labor  is 
good  for  every  resulting  profession  except 
that  of  the  minister,  but  what  I  wish  here 
to  point  out  is  that  in  this  field,  as  in  many 
others,  division  of  labor  is  never  an  un- 
mixed blessing  and  may  easily  become  a 
curse  unless  energy  and  intelligence  are 
devoted  to  the  ways  and  means  of  attain- 
ing a  close  co-operation  and  interchange 
of  ideas,  methods,  and  plans  among  the 
divided  laborers. 

There  is  a  distinction  and  an  important 
one  between  the  troubles  of  mind,  of  body, 
and  of  estate;  but  there  is  also  a  unity 
among  them.  Hence  no  one  can  give  the 
most  efficient  aid  to  a  diseased  body,  a  dis- 
tracted or  undeveloped  mind,  or  a  needy 
family  without  crossing  the  dividing  lines 
and  laboring  in  fields  assigned  primarily 
to  others.  A  doctor  needs  to  know  some- 
thing of  social  work  and  of  the  spiritual 
and  mental  life  of  his  patients.  A  social 
worker  must  know  something  of  physi- 


94  SOCIAL  SERVICE  AND 

ology  and  hygiene,  and  all  educators, 
whether  lay  or  clerical,  must  know  some- 
thing both  of  medicine  and  of  social  work. 
I  recently  saw  a  priest  create  a  strong, 
but  most  unfavorable,  impression  at  the 
graduation  exercises  of  a  training  school 
for  nurses  when  he  said,  addressing  the 
doctors  and  nurses  present :  ''  You  deal 
with  the  body,  1  with  the  soul."  Our  prac- 
tice has  gone  far  beyond  this  academic 
theory.  Despite  Professor  Miinsterberg's 
plea  for  armed  neutrality  ^  no  such  sharp 
boundaries  can  be  maintained.  The  an- 
cient controversy  between  materiaHsm  and 
spiritualism  is  ended.  There  are  no  crass 
materialists  or  rampant  spiritualists 
among  the  working  professions.  Matter 
and  spirit  belong  together ;  neither  of  them 
independent,  neither  slavishly  subordinate. 
Each  interpenetrates  everywhere  and  who- 
soever neglects  either  in  his  field  of  work 
comes  to  grief. 

^"Psychotherapy":  New  York,  1909. 


THE  ART  OF  HEALING  95 

Among  my  friends  I  am  proud  to  num- 
ber two  cousins  who  are  members  of  the 
famous  Worcester  family,  Elwood  Wor- 
cester of  Boston  and  Alfred  Worcester  of 
Waltham.  Both  are  doctors,  the  first  a 
doctor  of  divinity,  the  second  a  doctor  of 
medicine,  but  Elwood  Worcester,  the  min- 
ister of  reHgion,  is  now  known  and  blessed 
all  over  the  country  as  a  healer  of  souls 
(and  incidentally  of  bodies)  through  his 
psychotherapeutic  work  at  Emmanuel 
Church ;  while  Alfred  Worcester,  the  doc- 
tor, is  even  more  famous  as  a  trainer  of 
souls  than  as  a  healer  of  bodies.  Each 
is  distinguished  within  liis  own  narrower 
field;  each  is  still  more  distinguished  for 
his  success  in  work  that  overlaps  and  goes 
far  to  erase  the  faint  lines  of  division  be- 
tween his  own  profession  and  that  of  his 
cousin. 

Why  is  this  so? 

Simply  because  wherever  troubles  are 
heaped  up  and  gathered  together  as  they 


96  SOCIAL  SERVICE  AND 

are  in  a  hospital,  in  a  mission  church,  in 
the  offices  of  a  rehef  society,  we  find  that 
those  troubles  are  assorted.  They  are  not 
neatly  separated,  each  in  its  own  corner. 
They  do  not  heed  our  academic  distinc- 
tions or  our  divisions  of  labor.  Poverty, 
disease,  moral  shiftlessness,  and  spiritual 
torment  are  inextricably  intermingled  in 
the  face  and  fortunes  of  a  single  sufferer. 
Not  even  the  sufferer  himself  can  tell  what 
is  root  and  what  is  branch  among  his 
troubles.  He  will  wander  into  a  hospital 
in  search  of  a  tonic  ("  something  to  give 
me  strength,  doctor  ") ,  although  his  weak- 
ness may  be  due  to  lack  of  food  and  that 
lack  to  the  loss  of  his  job.  He  will  run 
to  a  clergyman  distracted  with  religious 
doubts  when  the  root  of  his  troubles  is  in- 
somnia. In  all  such  cases  he  goes  to  the 
wrong  shop  and  the  shopman  (doctor, 
minister,  social  worker)  is  apt  to  take  him 
at  his  own  valuation,  to  treat  him  for  his 
stomach  if  he  complains  of  that  or  for  his 


THE  ART  OF  HEALING  97 

atheism  if  that  is  the  burden  of  his  re- 
marks.   Disaster  often  results. 

Let  me  exemphfy  more  in  detail  the  ex- 
traordinary intermingling  of  the  afflictions 
of  mind,  body,  and  estate  as  we  meet  them 
in  all  sorts  and  conditions  of  men. 

I 

Mental  or  spiritual  turmoil  for  physical 
reasons 

(a)  Religious  ecstasies j  moral  doubts ^ 
and  self-condemnations  are  often  manifes- 
tations of  insanity,  of  hysteria,  of  neu- 
rasthenia, or  of  the  stresses  of  adolescence 
with  its  torrential  flood  of  developing  en- 
ergies. Suffering  of  this  kind  often  leads 
people  to  seek  help  from  a  clergyman. 
But  unless  the  clergyman  is  on  his  guard 
he  will  make  a  bad  matter  worse.  The  in- 
tense "  conviction  of  sin,"  which  such  a 
sufferer  often  experiences,  may  be  as  mor- 
bid as  the  dreams  of  an  opium  eater,  some- 
thing that  vanishes  and  ought  to  vanish 


98  SOCIAL  SERVICE  AND 

with  the  return  of  health.  The  rehgious 
ecstasies  and  visions  which  the  evangehst 
might  welcome  and  encourage  in  his  young 
pupil  may  yet  possess  no  more  spiritual 
significance  than  the  black  cats  and  snakes 
at  which  the  alcoholic  snatches  in  his  de- 
hrium.  I  am  far  from  asserting  that  all 
religious  visions  are  morbid.  I  am  merely 
recalling  the  well-known  fact  that  some 
rehgious  visions  are  morbid,  and  that  un- 
less clergymen  work  in  close  touch  with 
medical  men  and  medical  ideas  they  may 
do  unnecessary  harm  by  encouraging  the 
wrong  vision. 

(b)  Excessive  worry,  timidity,  scrupu- 
losity is  often  an  early  symptom  (though 
mistaken  for  the  cause)  of  arteriosclerosis, 
of  Bright's  disease,  ansemia,  or  tubercu- 
losis. "Poor  man!"  (people  say.) 
"  Business  worry,  too  heavy  responsibil- 
ities, too  long  hours  of  work  broke  him 
down."  Doubtless  this  is  sometimes  a 
true  bill,  but  irregular  meals,  frequent  nips 


THE  ART  OF  HEALING  99 

of  whiskey,  and  advancing  arterial  degen- 
eration are  often  more  potent  than  the 
psychical  causes.  A  child's  fear  of  the 
dark  may  vanish  after  a  summer  in  the 
open  air  and  return  again  after  a  winter's 
"  education "  in  stuffy  schoolrooms  and 
cramped  positions.  In  this  sense  it  is 
"  physical  "  in  origin. 

( c )  Laziness,  sMftlessness,  carelessness, 
may  be  only  the  mental  manifestations  of 
the  debility  of  adolescence,  of  chorea,  of 
cerebral  disease,  of  malnutrition,  or  of  any 
of  the  other  diseases  mentioned  above.  I 
once  heard  a  social  worker  illustrating  out 
of  her  own  bitter  experience  the  need  of 
more  medical  knowledge  or  medical  co- 
operation for  the  members  of  her  profes- 
sion: "  He  seemed  to  be  getting  lazier  and 
lazier,  every  motion  slower  and  slower.  It 
took  him  an  interminable  while  to  get 
dressed  and  out  at  work  in  the  morning. 
He  lost  place  after  place.  We  tried  first 
to  appeal  to  his  ambition,  then  to  his  af- 


100  SOCIAL  SERVICE  AND 

fection  for  his  wife  and  cliildren.  We 
tried  encouragement  and  reproof.  We 
got  the  priest  to  use  his  influence.  There 
was  some  improvement.  The  man  evi- 
dently tried  hard  for  a  time,  but  he  seemed 
to  get  no  satisfaction  out  of  his  dawning 
prosperity.  His  spirits  sank  lower  and 
lower,  till  he  was  so  depressed  that  an 
alienist  was  consulted.  Insanity  was  the 
expert's  verdict;  and  all  that  I  had  inter- 
preted as  moral  slackness  was  undoubt- 
edly, he  said,  the  '  psycho-motor  retarda- 
tion '  characteristic  of  an  early  stage  of 
depressive-manic  insanity.  He  is  in  an 
asylum  still.  I  ^^dsh  I  hadn't  plagued  him 
so  for  what  wasn't  his  fault." 

But  though  I  am  keenly  aware  of  the 
dangers  of  mistakes  due  to  overlooking  the 
physical  conditions  just  alluded  to,  I  think 
that  we  all  of  us,  doctors,  teachers,  minis- 
ters, social  workers,  need  to  be  just  as  alert 
to  avoid  the  opposite  error. 


THE  ART  OF  HEALING  101 

II 

Physical  complaints  and  even  diseases  may 
he  due  to  mental  and  spiritual  causes ^  to 
ignorance  J  mental  disease,  and  sin 

(a)  The  fear-neuroses,  the  habit-pains, 
the  hysterical  paralyses,  spasms,  and  an- 
aesthesias are  among  the  more  common 
and  obvious  examples,  often  wrongly 
treated  by  drugs  and  physical  means  alone. 

(b)  Many  people  are  sick  because  of 
remorse  more  or  less  stifled,  because  of  an- 
imosities or  shghts  brooded  over,  because 
of  loss  or  disappointment  to  which  they  do 
not  become  reconciled. 

(c)  Ignorance  of  the  laws  of  health,  of 
the  workings  of  the  organs  of  nutrition 
and  reproduction,  of  the  influence  of  mind 
on  body  and  of  body  on  mind  is  certainly 
a  prohfic  cause  of  disease. 


102  SOCIAL  SERVICE  AND 

III 

Financial  dependence  and  want  is  more 
and  more  often  seen  to  he  the  result  of 
physical  and  mental  causes.  People  are 
poor  because  they  are  sick  and  ignorant 

In  illustration  of  tliis  I  need  only  re- 
mind you  of  the  great  prevalence  of  tuber- 
culosis, typhoid,  and  other  infectious  dis- 
eases among  the  poor,  and  of  the  facts 
cited  by  Lee  K.  Frankel,  in  the  article  to 
which  I  have  already  referred  (see  page 
76).  In  62  out  of  100  successive  cases 
applying  to  a  rehef  agency  the  destitution 
of  the  apphcant  was  due  to  illness. 

Old  age,  accident,  alcohohsm,  acute  and 
chronic  disease,  the  death  of  the  bread  win- 
ner, are  among  the  commonest  causes  of 
financial  distress  in  America.  Hence  the 
social  worker  must  be  in  the  closest  touch 
with  physicians  and  must,  in  my  opinion, 
know  a  good  deal  of  medicine,  as,  in  fact, 
he  often  does. 


THE  ART  OF  HEALING  103 

In  the  last  chapter  I  tried  to  show  how 
far  character- defects  are  responsible  for 
many  of  the  problems  with  which  social 
workers  are  concerned.  Here  I  will  not 
repeat  what  was  then  said.  That  the  diag- 
nosis and  treatment  of  character  in  difficul- 
ties is  the  business  of  social  workers  who 
deal  with  children,  with  delinquents  and 
the  whole  field  of  probation  work  is,  I 
think,  obvious.  It  is  not  quite  so  obvious 
that  behind  the  effort  to  remove  any  of 
the  causes  of  financial  troubles  or  poverty 
is  an  educational  problem.  We  ought  to 
educate  somebody  every  time  we  receive 
an  application  for  financial  relief.  It  may 
be  the  applicant  himself  whose  ignorance, 
forgetfulness,  lack  of  imagination  or  of 
concentration  are  responsible  for  his  fail- 
ure. More  often  it  is  the  duty  of  the  so- 
cial worker  to  begin  an  educational  cru- 
sade against  the  ignorance  of  those  who 
are  responsible  for  the  bad  conditions 
which  produced  the  bankruptcy.     Some- 


104  SOCIAL  SERVICE  AND 

one  in  the  community  surely  needs  educa- 
tion. It  may  be  the  employer  who  permits 
unsanitaiy  work-conditions,  though  they 
may  hurt  liis  own  pocket  as  well  as  the 
health  of  his  employees.  It  may  be  the 
legislators  whose  error  of  omission  or  of 
commission  are  responsible  for  health- 
kilhng  conditions  in  factories,  schools, 
tenements,  and  railroads.  It  may  be  the 
bargain  hunters  and  the  fashion  slaves, 
whose  shortsightedness  makes  starvation 
wages  and  irregular  employment  so  com- 
mon. 

But  however  difficult  it  may  be  to  catch 
the  man  who  needs  education,  we  may  be 
sm'e  that  he  is  there  and  we  must  make  an 
intelligent  effort  to  find  and  to  "  reach  " 
liim,  so  fatally  dependent  are  mind,  body, 
and  estate;  the  mind  of  one  and  the  body 
and  estate  of  others,  in  this  field. 

So  far  I  have  spoken  of : 

1.  The  dependence  of  mental  on  bodily 
trouble. 


THE  ART  OF  HEALING  105 

2.  The  dependence  of  bodily  on  mental 
trouble. 

3.  The  dependence  of  financial  on  bod- 
ily and  mental  trouble. 

Naturally  enough  the  interdependen- 
cies  which  I  have  been  pointing  out  are 
tending  to  bring  together  again  the  doctor 
and  the  social  worker,  whose  now  divided 
functions  were  once  united,  and  to  empha- 
size for  them  both  the  importance  of  edu- 
cation in  the  remedy  of  all  mental,  physi- 
cal, and  financial  troubles.  What  I  have 
said  may  be  thus  summed  up : 

Doctor  and  social  worker  must  each 
look  to  the  other  for  the  causes  of  the 
trouble  he  seeks  to  cure.  At  bottom 
medical  ills  are  largely  social,  and  social 
ills  largely  medical.  But  both  doctor  and 
social  worker,  when  they  have  learned 
{each  from  the  other)  the  deeper  causes  of 
their  patients'  ills,  must  go  hand  in  hand 
to  the  educator,  or  at  any  rate  must  betake 
themselves  to  educational  methods,  when 


106  SOCIAL  SERVICE  AND 

they  get  through  with  diagnosis  and  begin 
treatment. 

The  dependence  of  doctor  and  social 
worker  on  education  and  on  the  educator 
has  been  made  so  clear  by  the  success  of 
educational  campaigns  against  tubercu- 
losis, alcoholism,  child  labor,  dark  tene- 
ments, and  unprotected  machinery  that  I 
do  not  care  to  dwell  on  it  here.  I  wish 
rather  to  point  out  the  reverse,  namely : 

The  dependence  of  the  educator  on  the 
doctor  and  on  the  social  worker. 

The  educator  and  those  in  charge  of 
education  are  becoming  increasingly  aware 
of  the  fact  that  since  a  compulsory  school 
law  forces  the  children  to  undergo  many 
dangers  (as  well  as  to  receive  many  bene- 
fits), justice  and  common  sense  say: 
"  Neutralize  so  far  as  possible  the  peculiar 
dangers  of  school  life."  Such  dangers 
are : — 

1.  Those  resulting  from  keeping  your 


THE  ART  OF  HEALING  107 

children  indoors  and  making  them  sit  still 
and  use  small  muscles  (eye  and  hand) . 

2.  Those  resulting  from  eyestrain. 

3.  Those  resulting  from  acute  infectious 
diseases  and  from  tuberculosis. 

4.  Those  resulting  from  discourage- 
ment, ostracism,  and  handicapping  of 
the  child  by  adenoids  or  speech  defect,  ac- 
centuated by  school  work  and  school  dis- 
cipline. 

To  neutralize,  prevent,  or  minimize 
these  evils,  the  school  authorities  are  be- 
ginning to  institute : 

(a)  Physical  as  well  as  mental  exam- 
inations (especially  in  New  York  and  Bos- 
ton) . 

(b)  Psycho-physical  tests  (especially 
in  Chicago  and  Philadelphia) . 

(c)  School  nurses. 

(d)  Physical  training,  school-gardens, 
and  proper  playgrounds. 

Since  the  causes  of  many  of  the  ills 
which  doctors,  educators,  and  social  work- 


108  SOCIAL  SERVICE  AND 

ers  are  combating  lie  across  the  boundaries 
that  separate  these  professions  from  each 
other,  the  reahzation  of  tliis  fact  plus  the 
desire  to  be  thorough,  to  leave  no  stone  un- 
turned in  searching  out  causes,  is  chang- 
ing all  three  professions. 


Changes  in  the  Medical  Profession 

Doctors  are  reahzing  that  they  must 
know  more  than  they  do  of 

(a)  Diagnostic  psychology:  i.e.,  the 
scientific  study  of  character  in  health  and 
in  disease. 

(b)  Therapeutic  psychology:  the  sys- 
tematic apphcation  of  mental  methods  to 
the  cure  of  disease. 

(c)  Educational  psychology:  the  sci- 
ence and  art  of  pedagogy  as  apphed  to  the 
training  of  sick  minds,  sick  wills,  and  un- 
governed  emotions. 

(d)  Social  work:  the  bearing  of  indus- 


THE  ART  OF  HEALING  109 

trial,  domestic,  and  economic  conditions  on 
health. 

(e)  The  possibiHties  of  moral,  and 
thereby  of  physical,  harm  resulting  from 
some  current  methods  of  treating  patients ; 
i.e.,  the  undermining  of  character  and  the 
disintegration  of  families  through  the  idle- 
ness and  isolation  forced  on  phthisical  pa- 
tients; the  drug-habits  and  doctor-habits 
produced  by  the  giving  of  placebos  and  the 
telHng  of  soothing  hes. 

(f)  Preventive  medicine:  (see  below). 

II 

Changes  in  the  Profession  of  Social  Work 

(a)  Social  workers  are  learning  and  ap- 
plying more  of  the  doctor's  stock-in-trade, 
physiology,  hygiene,  and  mental  healing. 

(b)  They  are  at  present  taking  the  lead 
in  preventive  medicine,  i.e.,  in  the  improve- 
ment of  milk  supplies,  tenements  and 
parks,  in  the  crusade  against  tuberculosis 
and  alcoholism,  in  the  organization  of  pub- 


110  SOCL\L  SERVICE  AND 

lie  sentiment  leading  to  legislation  for  the 
introduction  of  school  nui'ses,  the  medical 
examination  of  school  cliildren,  the  pass- 
age of  cliild  labor  laws,  pure  food  and  drug 
laws,  the  medical  inspection  of  factories^ 
dairies,  bakeries,  and  packing  houses. 

(c)  Social  workers  are  finding  their 
place  in  hospitals,  factories,  and  churches 
where  the  social  problems  may  over- 
shadow the  industrial,  sm'gical,  or  techni- 
cally religious  work. 

(d)  Such  jDroblems  as  that  of  blindness, 
formerly  attacked  merely  from  the  medical 
side,  are  now  being  treated  from  the  edu- 
cational and  industrial  standpoint  by  so- 
cial workers. 

Ill 

Changes   in    the  profession   of   teaching 

both  clerical  and  secular 

(a)  Clergymen  and  other  teachers  are 
resuming  their  ancient  functions  of  min- 
istering to  sick  souls,  i.e.,  the  neurasthenics, 


THE  ART  OF  HEALING  111 

hysterics,  and  those  burdened  by  unreason- 
ing fears,  vicious  habits,  and  distracting 
thoughts. 

(b)  Lay  teachers  are  beginning  to  ap- 
ply to  their  teaching  some  rudimentary 
knowledge  of  physiology,  of  hygiene,  of 
psychology,  and  of  social  work. 

(c)  Hygiene  and  social  ethics  are  be- 
ginning to  be  taught  in  school. 

(d)  Schools  are  beginning  to  be  used  as 
social  centers,  for  evening  recreation 
classes,  clubs,  and  lectures. 

(e)  Colleges  are  providing  free  public 
lectures  on  medical  topics  and  are  begin- 
ning to  take  more  responsibility  for  the 
student's  whole  character  and  not  merely 
for  his  intellectual  development.^ 

One  Result  of  These  Changes 

No  one  can  have  followed  the  history  of 
the  last  ten  years  in  medicine,  education, 

^Woodrow  Wilson:  Address  to  the  Phi  Beta  Kappa 
Society  at  Harvard,  July  1st,   1909,  and  A.   Lawrence 


112  SOCIAL  SERVICE  AND 

and  social  work  and  noted  the  increasing 
evidence  of  their  interpenetration  and 
closer  co-operation  without  discerning: 

(a)  The  rapid  growth  of  public  med- 
icine, whose  method  is  educational,  pre- 
ventive, and  sociological; 

(b)  The  consequent  restriction  of  the 
sphere  of  the  "  private  doctor." 

With  the  increasing  power  and  respect 
commanded  by  municipal,  state,  and  na- 
tional health  boards  it  becomes  possible  for 
such  boards  to  open  and  manage  a  munici- 
pal milk-depot  with  teacher  nurses,  as  in 
Rochester,  N.  Y. ;  to  enforce  the  anti-spit- 
ting laws  as  in  parts  of  New  York  City; 
to  investigate  and  control  bakeries,  dairies, 
packing  houses,  and  water  supphes.  Even 
Philadelphia  has  finally  (1909)  ceased  to 
endure  public  murder  (through  typhoid 
germs)  at  the  hands  of  its  city  govern- 
ment. 

Lowell:  Competition  in  College,  Atlantic  Monthly,  June, 
1909. 


THE  ART  OF  HEALING  113 

National  medicine  made  a  start  in  1900 
when  it  unmasked  the  Hes  and  trickery  by 
which  the  San  Francisco  city  government 
concealed  the  existence  of  bubonic  plague 
in  that  city.  It  advanced  a  long  step  in 
1904  when  Colonel  Gorgas  was  promoted 
from  a  subordinate  medical  officer  to  a  full 
member  of  the  Panama  Canal  Commission 
and  given  power  to  stamp  out  yellow  fever 
and  to  curb  malaria  on  the  Isthmus.  It 
advanced  two  long  steps  in  1907  when  the 
Meat  Inspection  bill  brought  the  packers 
to  their  senses,  and  the  Pure  Food  and 
Drug  bill  broke  the  power  of  the  Patent 
Medicines. 

School  hygiene  has  now  become  the  most 
important  branch  of  public  medicine,  for 
in  the  school  population  the  state  can  in- 
fluence the  health  of  all  its  future  citizens, 
putting  its  guiding  hand  upon  them  at  the 
most  critical  period  in  their  lives.  School 
nurses,  medical  inspection,  and  systematic 
treatment  of  school  children,  school  play- 


114  SOCIAL  SERVICE  AND 

grounds  under  the  control  and  manage- 
ment of  the  school  itself  ( as  by  the  IMassa- 
chusetts  law  of  1907)  ;  the  teaching  of  hy- 
giene, mental  and  physical,  in  schools  and 
colleges,  all  mark  a  long  step  in  the  ad- 
vance of  public,  preventive,  educational 
medicine. 

This,  together  mth  the  development  of 
factory  insjDection,  protection  of  machin- 
ery, tenement  house  legislation,  pubhc 
parks,  baths  and  playgrounds,  the  grow- 
ing efficiency  of  pubhc  diagnosis-labora- 
tories and  free  drugs  (quinine,  diphtheria 
anti-toxin,  and  in  Porto  Rico  thymol) ,  is 
driving  the  private  doctor  more  and  more 
to  the  wall.  The  "  good,  old-fashioned  " 
epidemics  of  typhoid,  diphtheria,  and  ma- 
laria are  getting  rarer  and  the  doctors  are 
feeling  the  loss  of  income.  Yellow  fever 
and  smallpox  are  gone.  The  number  of 
chronic  invahds  requiring  long  and  ex- 
pensive medical  attendance  is  being  dimin- 
ished by  the  growth  of  successful  surgery. 


THE  ART  OF  HEALING  115 

of  efficient  psychotherapeutics,  of  outdoor 
life,  and  by  the  sanatorium  treatment  of 
tuberculosis. 

Partly  as  a  result  of  this,  the  number  of 
doctors  and  of  medical  students  has  begun 
within  the  past  five  years  to  diminish  not 
only  in  America  but  in  all  parts  of  Eu- 
rope. We  doctors  are  actually  beginning 
to  abohsh  ourselves  by  merging  ourselves 
in  the  wider  profession  of  public,  prevent- 
ive medicine,  whose  activities  are  inextri- 
cably interwoven,  as  this  chapter  aims  to 
show,  with  social  and  educational  work.  I 
am  thankful  that  it  is  so. 

Here  are  the  cheerful  facts : ' 


1905                    1908 

Medical  students 

25,835                 22,787 

Population   of    TJ.    S. 
(estimated) 

83,143,000 

87,170,000 

Ratio  of  students  to 
population 

1  :  3,218 

1  : 3,825 

iSee    Report    of    U.    S.    Commissioner   of    Education. 
Vol.  II,  p.  777,  1908. 


CHAPTER  IV 

JEAM-WORK     OF     DOCTOR     AND     PATIENT 

THROUGH   THE  ANNIHILATION 

OF   LYING 

Team-work^  genuine  co-operation,  has 
been  my  guiding  interest  throughout  this 
book.  It  is  largely  because  people  can't 
or  won't  pull  together  that  the  world 
moves  on  no  faster  than  it  does.  We  are 
held  apart  by  professional  narrowness  and 
professional  case-hardening  (as  when  a 
nurse  refuses  to  help  a  gasping,  broken- 
winded  teamster  up  the  hospital  stairs, 
"  because  it  is  the  ward  tender's  busi- 
ness"), or  by  mutual  suspicion  (as  be- 
tween ministers  and  doctors),  or  simply 
by  ignorance  of  each  other's  existence. 
But  still  more  I  think  we  hold  each  other 
at  arm's  length  by  our  persistent  habits 

116 


THE  ART  OF  HEALING  117 

of  lying  and  prevarication.  A  doctor  lies 
to  liis  patient  about  the  medicine  which  he 
is  asked  to  take.  The  patient  pours  the 
medicine  down  the  sink  and  hes  to  the 
doctor  about  it.  Poor  team-work,  that! 
Friends  cool  down  to  mere  acquaintance- 
ship because  their  cordial  faces  and  effu- 
sive manners  don't  prevent  their  reading 
behind  the  mask  (with  the  marvelous  in- 
sight of  aroused  suspicion)  what  each  has 
said  of  each  in  other  company. 

I  beheve  that  the  art  of  heahng  is  going 
to  spring  ahead  with  astonishing  swiftness 
in  the  next  decade  because  the  community 
is  coming  to  reahze  that  doctor  and  patient 
can  work  together  to  exterminate  or  hmit 
disease.  Preventive  medicine,  first  fos- 
tered by  the  social  workers  and  by  the 
national  government,  now  tardily  taken 
up  by  the  medical  profession  in  great  cities, 
makes  for  frankness,  for  education  of  the 
whole  public,  for  the  general  diffusion  of 
medical  knowledge,  and  for  the  abolition 


118  SOCIAL  SERVICE  AND 

of  professional  secrecy  and  unprofessional 
buncombe. 

But  the  battle  is  still  not  won.  Far 
from  it !  The  great  bulk  of  medical  work, 
pubhc  and  private,  is  still  done  by  men — 
high-minded  men — who  beheve  that  it  is 
impossible  to  deal  frankly  and  openly  with 
patients.  The  social  workers  are  not  al- 
ways as  truthful  as  they  might  be.  The 
head  of  a  great  humanitarian  enterprise 
recently  asked  me  to  co-operate  Tvdth  her  in 
a  complicated  deception  of  one  of  her  tem- 
porary employees.  When  I  remonstrated 
with  her,  she  quoted  to  me  Lecky's  saying 
that  in  such  matters  we  must  be  guided  by 
"  a  combination  of  good  sense  and  good 
feeling."  Her  good  sense  and  good  feeling 
taught  her  to  he  in  the  same  kindly  pater- 
nal way  used  by  many  doctors  when  they 
fool  their  patients,  strictly  for  the  latter's 
good,  but  still  to  the  destruction  of  all 
team-work  and  enlightenment. 

I  have  thought  it  worth  while,  therefore, 


THE  ART  OF  HEALING  119 

w  report  as  objectively  as  I  can  my  own 
experience  with  lying  and  with  veracity  in 
medicine. 

I  approach  the  subject  of  truth  in  med- 
^  icine,  not  from  the  point  of  view  of  scien- 
tific method,  nor  of  metaphysical  analysis, 
but  of  professional  ethics.  I  do  not  ask 
"  how  can  we  find  truth,"  nor  "  what  is 
truth,"  but  "  how  far  should  we  speak  the 
truth  in  deahng  with  our  patients,  our  col- 
leagues, or  anyone  else?  "  "  Are  lies  ever 
in  place?    If  so,  under  what  conditions?  " 

My  method  is  experimental,  the  only 
one  in  which  reasonable  men  place  confi- 
dence, the  only  sound,  scientific  method. 
I  shall  not  discuss  the  general  principles, 
the  authorities,  or  traditions  which  might 
guide  our  course  in  this  matter.  As  in- 
dicated in  the  title  of  this  chapter  I  have 
made  an  experimental  study  of  two  dif- 
ferent hypotheses  on  the  subject,  submit- 
ting them  to  the  test  of  experience,  as  any 
candid  person  must,  if  he  wishes  to  make 


120  SOCIAL  SERVICE  AND 

the  fairest  judgment  in  his  power  on  any 
question.  I  have  been  working  on  this 
subject  during  a  considerable  part  of  the 
last  eighteen  years,  and  my  conclusions, 
however  faulty  they  may  be,  must  be 
criticised  hke  any  other  piece  of  scientific 
work  only  by  those  who  have  repeated  the 
experiments  on  which  they  are  based. 

I  began,  as  was  natural,  with  the  hy- 
pothesis on  which  I  had  been  brought  up. 
My  medical  training  included  some  few 
lectures  on  medical  ethics,  but  in  such  mat- 
ters example  far  more  than  precept  was 
the  guide  of  the  Harvard  medical  student 
of  my  day.  Only  once  during  my  course 
was  the  question  of  veracity  in  medical 
matters  directly  treated. 

"  When  you  are  thinking  of  telling  a 
lie,"  said  the  teacher,  "  ask  yourself 
whether  it  is  simply  and  solely  for  the  pa- 
tient's benefit  that  you  are  going  to  tell 
it.  If  you  are  sure  that  you  are  acting 
for   his    good    and    not    for    your    own 


THE  ART  OF  HEALING  121 

profit,  you  can  go  ahead  with  a  clear 
conscience." 

The  hes  which  the  medical  profession 
agree  in  condemning  are  those  told  for  per- 
sonal and  private  gain.  The  magazine 
article  representing  work  never  performed 
and  written  solely  for  advertising  pur- 
poses, is  a  lie  that  no  one  approves.  The 
diagnosis  of  diphtheria  when  the  physician 
knows  the  case  is  merely  one  of  tonsilitis,  is 
not  justified  by  the  increased  fees  which  his 
frequent  visits  entail.  There  is  no  dis- 
agreement of  opinion  among  physicians 
about  such  Kes  as  these. 

But  the  lies  which  are  usually  defended 
among  physicians  are  of  a  different  type 
and  may  be  illustrated  by  the  following 
quotations : 

"  The  young  physician  in  our  day  has 
some  advantages  in  competition  with  older 
men.  People  sometimes  consider  a  young 
man  more  up-to-date  than  his  elders.  Still 
there  are  some  alleviations  in  growing  old. 


l^S  SOCIAL  SERVICE  AND 

When  you  don't  know  what's  the  matter 
with  a  patient  you  can  then  enjoy  the 
luxury  of  sapng  so.  When  you're  young 
you  have  to  know  everything,  for  if  you 
say  you  don't  know,  the  patient  is  hkely 
to  chuck  you  out  and  send  for  someone 
else,  who  does." 

That  veracity  in  diagnosis  is  possible  for 
the  older  physician,  but  not  always  for  the 
younger,  seems  to  be  the  moral  of  this 
quotation. 

Veracity  in  prognosis  is  even  harder. 
In  the  course  of  a  lecture  on  the  prognosis 
of  heart  disease,  I  once  heard  the  follow- 
ing story: 

A  business  man  past  middle  life  was 
found  to  be  suffering  from  some  form  of 
heart  disease.  His  wife  inquired  about  the 
diagnosis  and  hearing  it  was  heart  disease, 
she  asked:  "  Isn't  it  true  that  he  may  drop 
dead  suddenly?  "  The  doctor  had  to  con- 
fess that  this  was  a  possibihty.  "  The  con- 
sequence was,"  went  on  the  story-teller. 


THE  ART  OF  HEALING  123 

"  that  day  after  day  she  sat  at  her  window 
about  the  time  that  her  husband  should  be 
returning  from  business,  watcliing  to  see 
whether  he  would  come  home  on  his  feet 
or  in  an  ambulance." 

"  Now,"  said  the  narrator,  "  when  you 
get  into  practice,  gentlemen,  whatever 
you  do,  don't  do  that.  Don't  make  a 
woman's  hfe  miserable  because  you  can't 
keep  a  fact  to  yourself." 

Surely  it  seems  as  if  this  is  the  place 
for  a  good  straight  lie.  I  thought  so  when 
I  heard  the  story  and  made  up  my  mind 
that,  whatever  blunders  I  made  in  dealing 
with  any  patients  I  might  have,  this  one 
I  would  avoid.  But  I  found  it  more  diffi- 
cult than  I  had  anticipated.  It  was  not 
very  many  years  before  I  saw  in  consulta- 
tion a  case  the  duplicate  of  that  just  de- 
scribed. Mr.  B.  had  angina  pectoris,  with 
serious  disease  of  his  heart  and  kidneys. 
He  needed  rest.  He  had  refused  to  take 
it,  and  the  chances  were  that  he  would 


124  SOCIAL  SERVICE  AND 

continue  to  force  himself  along  until  he 
dropped  in  Ms  tracks.  After  I  had  talked 
over  the  case  with  the  attending  physician 
and  was  about  to  return  and  say  a  word  to 
the  family,  my  colleague  said:  "  There's 
one  thing  I  must  warn  you  about.  This 
man's  wife  is  an  excessively  nervous,  excit- 
able woman  of  no  stamina  at  all.  She  gets 
hysterical  on  the  slightest  pretext,  and 
when  that  happens  she  makes  everyone 
else  in  the  house  sick.  If  she  hears  what's 
the  matter  with  her  husband,  she'll  go  all  to 
pieces.  So  you'll  be  very  guarded  in  what 
you  say,  won't  you?  "  To  this  I  readily 
agreed.  Remembering  my  lesson,  we  went 
downstairs  where  Mrs.  B.  was  waiting  to 
hear  the  result  of  our  dehberations.  She 
placed  a  chair  for  me  and  then  planted  her- 
self in  another,  squarely  facing  me  and 
very  near.  "  Now,  first  of  all,"  said  she, 
"  I  want  to  know  whether  you  are  going  to 
give  me  a  straight  and  true  answer  to 
everything   I  ask  you?  "     Having  just 


THE  ART  OF  HEALING  125 

promised  the  family  physician  that  I 
would  do  nothing  of  the  kind,  I  was  so 
taken  aback  that  I  hesitated  a  moment. 
"  That's  enough,"  said  Mrs.  ,B.,  getting 
up.  "  I  don't  care  to  hear  anything  more 
from  you." 

I  did  not  blame  her.  She  had  fairly 
caught  us  in  our  attempt  to  trick  her.  But 
the  anecdote  shows  that  the  path  of 
the  medical  man  who  conscientiously 
tries  to  shield  people  from  pain  and 
trouble  is  sometimes  a  difficult  and 
thorny  one. 

By  means  of  these  examples  I  hope  I 
have  succeeded  in  making  clear  the  prob- 
lems that  I  wish  next  to  discuss  more  in 
detail. 

I  propose  now  to  consider:  (1)  Veracity 
in  diagnosis;  (2)  Veracity  in  prognosis; 
(3)   Veracity  in  treatment. 

By  veracity  I  mean  doing  one's  best  to 
convey  to  another  person  the  impression 
that  one  has  about  the  matter  in  hand. 


126  SOCIAL  SERVICE  AND 

One  may  do  one's  best  and  yet  fail;  but 
that  is  not  lying.  I  once  spent  half  an 
hour  trying  to  convey  to  my  parlor  girl 
my  impression  about  how  to  build  a  wood 
fire,  but  when  she  next  tried  to  build  one 
it  appeared  that  the  only  idea  she  had  re- 
ceived was  that  of  packing  kindling  wood 
into  the  fireplace  as  tightly  as  she  could 
and  piHng  logs  on  top,  without  lea^dng 
a  chink  or  cranny  anj^^vhere  for  a  draft. 
Clearly  I  did  not  succeed  in  conveying  my 
impression  to  her,  yet  I  suppose  no  one 
^yi]l  accuse  me  of  lying  to  her. 

A  true  impression,  not  certain  words 
literally  true,  is  what  we  must  iry  to  con- 
vey. When  a  patient  who  has  the  earhest 
recognizable  signs  of  phthisis  in  one  lung, 
and  tubercle  bacilh  in  liis  sputum,  asks, 
"  Have  I  got  consumption?  "  it  would  be 
conveying  a  false  impression  to  say,  "  Yes, 
you  have,"  and  stop  there.  Ten  to  one  his 
impression  is  that  by  consimiption  I  mean 
a   disease   invariably   and   rapidly   fatal. 


THE  ART  OF  HEALING  127 

But  this  is  not  at  all  my  impression  of  his 
case.  To  be  true  to  that  patient  one  must 
explain  that  what  he  means  by  consump- 
tion is  the  later  stages  of  a  neglected  or 
unrecognized  disease;  that  some  people 
have  as  much  trouble  as  he  now  has  and 
get  over  it  without  finding  it  out ;  that  with 
climatic  and  hygienic  treatment  he  has  a 
good  chance  of  recovery,  etc.  To  tell  him 
simply  that  he  has  consumption  without 
adding  any  further  explanation  would 
convey  an  impression  which  in  one  sense  is 
true,  in  the  sense,  namely,  that  to  another 
physician  it  might  sound  approximately 
correct.  What  is  sometimes  called  the 
simple  truth,  the  "  bald  truth,"  or  the 
"  naked  truth,"  is  often  practically  false — 
as  unrecognizable  as  Lear  naked  upon  the 
moor.  It  needs  to  be  explained,  supple- 
mented, modified. 

Bearing  in  mind,  then,  that  by  veracity 
I  mean  the  faithful  attempt  to  convey  a 
true  impression,  and  by  lying  an  inten- 


128        •     SOCIAL  SERVICE  AND 

tional  deception,  however  brought  about; 
let  us  take  up  the  question  of 


Truth  and  Falsehood  in  Diagnosis 

The  common  conception  of  a  doctor's 
duty  in  this  matter,  and  one  according  to 
wliich  I  practiced  medicine  for  the  first 
five  or  six  years  after  my  graduation,  is 
sometliing  as  follows: 

"  Tell  the  truth  so  far  as  possible.  But 
if  you  are  young  and  not  yet  firmly  estab- 
hshed  in  practice,  it  won't  do  to  let  the  pa- 
tient or  his  family  know  when  you  are  in 
doubt  about  a  diagnosis.  If  you  do,  they 
\sdll  lose  confidence  in  you  and  perhaps 
turn  you  out." 

That  is  what  is  implied  in  the  frank  and 
refreshing  confession  of  a  middle-aged 
and  successful  physician  w^hose  words  I 
have  already  quoted:  "  The  great  ad- 
vantage of  getting  old  is  that  when  you 


THE  ART  OF  HEALING  129 

don't  know,  you  can  enjoy  the  luxury  of 
saying  so." 

The  first  experience  that  made  me  doubt 
whether  it  was  necessary  for  a  young  prac- 
titioner to  pretend  omniscience  in  order  to 
retain  his  patients'  confidence  was  the  fol- 
lowing: I  had  the  opportunity  of  dri\dng 
about  a  large  town  some  twenty-five  miles 
from  Boston  with  a  young  physician  only 
a  year  or  two  my  senior.  He  took  me  on 
his  regular  rounds;  we  saw  farmers  and 
the  grocer's  wife,  the  hotel-keeper's  daugh- 
ter, and  the  blacksmith's  baby,  as  well  as 
one  or  two  well-to-do  people.  The  great 
majority  of  the  cases  were  in  families  of 
very  hmited  education,  the  kind  of  folks 
that  we  think  of  as  subsisting  mostly  on 
pies  and  patent  medicine.  But  what  made 
each  case  an  eye-opener  to  me  was  the 
utter  frankness  of  the  doctor  with  the 
families.  Diagnosis,  prognosis,  and  treat- 
ment were  given  with  an  absence  of  subter- 
fuge and  of  prevarication  that  astounded 


130  SOCIAL  SERVICE  AND 

me,  and  what  surprised  me  even  more  was 
to  see  the  way  the  patients  hked  his  frank- 
ness. I  never  have  seen  manifested  more 
imphcit  confidence  in  a  physician  than 
during  that  drive.  He  never  forced  his 
doubts  or  his  suspicions  upon  his  patients, 
but  when  they  asked  a  straight  question 
they  got  a  straight  answer.  A  baby  had  a 
fever.  "  What's  the  baby  got?  "  asked  its 
mother.  "  Can't  tell  j^et,"  said  the  doctor; 
"  may  be  going  to  break  out  with  some- 
tliing  to-morrow,  or  it  may  be  all  right  in 
a  day  or  two.  We  shall  have  to  wait  and 
see."  There  was  no  talk  of  "  febricula  " 
or  "  gastric  fever."  Not  once  did  I  hear 
liim  say  that  a  patient  was  "  threatened  " 
with  any  disease.  He  knew  that  Nature 
makes  no  threats  and  that  no  honest  doctor 
ever  foists  his  ignorance  upon  "  Nature  " 
by  charging  her  mth  making  a  "  threat." 
I  asked  him  the  obvious  question: 
"  How  can  you  be  so  frank  with  your 
patients  and  yet  keep  their  confidence?  " 


THE  ART  OF  HEALING  131 

"  Because  they  know,"  said  he,  "  that 
whenever  anything  unusual  comes  up  that 
I  can't  handle  or  that  puzzles  me  I  have 
a  consultant.  So  when  I  say  that  I  do 
know,  they  beheve  me,  and  when  I  say  I 
don't  know  and  yet  don't  call  in  a  con- 
sultant they  understand  that  nothing  of 
any  seriousness  is  the  matter,  and  that  they 
don't  need  to  worry.  Lots  of  men  are 
afraid  to  call  a  consultant  because  they 
are  afraid  the  family  will  think  the  less 
of  their  ability.  But  it  makes  the  family 
feel  a  great  deal  safer  to  know  that  I  don't 
pretend  to  know  everytliing  and  stand 
ready  any  moment  to  call  in  someone  who 
knows  more  than  I  do.  I've  seen  a  man 
lose  a  family  because  he  didnt  have 
a  consultant,  but  never  because  he 
did." 

"  Don't  the  families  ever  object  to  the 
expense  of  a  consultant?  "  I  asked. 

"  No,"  said  he,  "  it's  perfectly  easy  to 
get  good  consultants  at  low  prices  if  you 


1S2  SOCIAL  SERVICE  AND 

explain  the  family's  circumstances  to 
them." 

As  a  result  of  that  conversation  I  began 
cautiously  to  try  the  experiment  of  telKng 
the  truth,  whether  I  understood  the  case 
thoroughly  or  not.  I  never  had  reason  to 
regret  it,  and  I  am  every  year  more  firmly 
convinced  that  the  young  doctor,  even 
when  practicing  cliiefly  among  uneducated 
people,  does  not  need  to  pretend  omni- 
science merely  because  he  is  young  and  his 
patients  ignorant.  The  truth  works  just 
as  well  for  the  pocket,  and  a  great  deal 
better  for  the  community  and  for  our  own 
self-respect. 

"  A  certain  profession  of  dogmatism," 
said  Sir  Frederick  Treves  in  an  address  ^ 
to  medical  students,  "  is  essential  in  the 
treatment  of  the  sick.  The  sick  man  will 
allow  of  no  hesitancy  in  the  recognition  of 
disease.  He  blindly  demands  that  the  ap- 
pearance of  knowledge  shall  be  absolute, 

^  British  Medical  Jourrial,  October  18,  1902. 


THE  ART  OF  HEALING  133 

however  shadowy  and  unsubstantial  may 
be  the  bases  of  it." 

This  declaration  has  the  great  merit  of 
frankness.  But  how  would  a  doctor  Hke 
to  have  his  patients  hear  those  words? 
How  would  he  hke  to  be  caught  by  his 
patients  in  the  act  of  passing  on  to  medical 
students  such  little  tricks  of  the  trade  as 
this  ?  It  is  true  that  his  address  may  never 
come  to  his  patients'  ears;  he  may  never 
be  found  out.  But  is  it  good  for  us  as 
professional  men  to  have  our  reputations 
rest  on  the  expectation  of  not  being  found 
out? 

I  doubt  beside  whether  ( as  Dr.  Gould  ^ 
once  pointed  out  in  an  admirable  editorial) 
we  "  succeed  in  humbugging  the  patient's 
relations  and  friends  by  the  devices  which 
apparently  suit  the  patient.  Among  intelh- 
gent  laymen,  far  more  frequently  than  is 
supposed,  one  finds  that  such  sham  cer- 
tainty without  the  reality  of  knowledge 

*  American  Medicine,  November  1,  1902,  p.  681. 


134  SOCIAL  SERVICE  AND 

and  con^dction  is  at  once  detected.  Doc- 
tors make  a  great  mistake  when  they  think 
their  deceits  really  deceive. 

Then  there  is  the  patient  who  recovers. 
When  he  is  well,  the  false  diagnoses,  the 
changes  of  dogmatic  opinions  and  of  medi- 
cines, the  bhnd  alley  of  proved  errors, 
these  are  thought  over." 

It  is  getting  steadily  harder  to  deceive 
the  pubhc.  Some  years  ago  I  heard  a 
prominent  and  representative  citizen  of 
Boston  commenting  upon  the  medical  bul- 
letins on  ex-President  Roosevelt's  leg. 
"Of  course,"  he  said,  "  no  one  ever  believes 
these  bulletins.  The  doctors  give  out  only 
so  much  as  they  tliink  fit,  in  order  not  to 
alarm  the  public  unnecessarily.  The  re- 
sult is  that  the  public  never  beheves  the 
bulletins    and    is    always    more    or    less 


anxious." 


Now,  I  do  not  beheve  that  the  truth  was 
in  any  way  tampered  with  in  the  bulletins 
either    of    President    Roosevelt's    or    of 


THE  ART  OF  HEALING  135 

President  McKinley's  illness.  I  believe 
these  bulletins  gave  the  strict  and  accurate 
truth.  But  I  think  it  is  generally  admitted 
that  such  bulletins  do  not  command  the 
respect  which  they  usually  deserve.  Busi- 
ness men  and  others  to  whom  it  may  be  of 
vital  importance  to  get  reliable  informa- 
tion about  the  illness,  are  especially  apt  to 
"  discount  "  the  bulletins  of  the  group  of 
physicians  in  attendance  on  a  man  whose 
hf  e  is  of  great  importance  financially.  We 
all  remember  how  persistently  the  general 
public  beheved  that  King  Edward's  illness 
of  1902  was  due  to  mahgnant  disease,  and 
not  to  the  "  perityphhtis  "  mentioned  in 
the  bulletins.  How  can  we  blame  the  pub- 
He  for  not  believing  the  doctors  in  attend- 
ance on  the  King  when  one  of  them,  Sir 
Frederick  Treves,  is  willing  publicly  to 
advocate  the  systematic  deception  of  pa- 
tients? His  words  I  have  quoted.  It  is 
true  that  he  does  not  advise  deception 
under  conditions  like  those  of  King  Ed- 


136  SOCIAL  SERVICE  AND 

ward's  illness,  but  how  is  the  pubHc  to 
know  just  when  and  how  far  the  doctor 
will  think  it  best  to  deceive?  Such  dis- 
crimination is  especially  difficult  in  a  coun- 
try like  England,  where  the  pubHc  can- 
not help  knowing  that  what  is  "  given  out  " 
concerning  foreign  affairs,  especially  in 
matters  of  dij)lomacy  and  war,  represents 
only  so  much  of  the  truth  as  the  officials 
think  it  best  for  the  public  to  know. 

I  have  been  speaking  of  the  disadvan- 
tages of  trjdng  to  deceive  a  patient  or 
those  interested  in  him  with  regard  to  the 
diagnosis.  I  have  argued  so  far  that  it  is 
not  necessary  to  assume  absolute  knowl- 
edge in  order  to  impress  the  patient's 
mind  and  hold  liis  confidence,  and  that 
owing  to  the  increasing  scepticism  of  the 
public,  it  is  becoming  more  and  more  diffi- 
cult to  fool  the  patient  at  all. 

Very  few  Americans  like  to  lie.  They 
would  rather  tell  the  truth  if  they  could, 
but  there  are  cases  in  which  the  voice  of 


THE  ART  OF  HEALING  137 

duty  itself  seems  to  tell  us  that  we  must 
lie.  To  prevent  the  breaking  up  of  a 
family,  to  save  a  life,  are  we  not  to  he? 
A  husband  confesses  to  you  the  sin  that 
has  resulted  in  disease  for  him.  The  wife, 
suspecting  something,  catches  you  on  your 
way  out  and  asks  you  point-blank  what 
ails  her  husband.  Can  you  tell  her  the 
truth?  Well,  suppose  you  tell  her  a  good, 
round,  well-constructed  he.  What  are  the 
chances  of  her  belie^dng  you?  If  she  has 
got  to  the  point  of  suspecting  her  husband, 
are  her  suspicions  likely  to  be  quieted  per- 
manently by  your  reassurances?  Is  there 
not  a  fair  chance  that  she  knows  enough  of 
the  usual  customs  of  physicians  when 
placed  in  this  position,  to  discount  what 
you  say? 

The  truth  in  such  matters  very  often 
comes  to  light  sooner  or  later,  and  if  it 
does,  the  wife  is  apt  to  let  a  number  of  per- 
sons know  what  kind  of  a  trick  you  have 
played  her.     Of  course,  there  are  many 


138  SOCIAL  SERVICE  AND 

such  cases  in  which  the  truth  is  never  found 
out,  but  I  ask  again,  is  it  a  good  thing  for 
us  as  professional  men  to  be  hving  in  the 
hope  of  not  being  found  out? 

II 

Truth  and  Falsehood  in  Prognosis 

That  it  is  a  bad  thing  to  lie  about  a 
prognosis  we  all  admit,  as  a  general  rule, 
but  there  are  cases  when  it  is  not  easy  to 
see  what  harm  it  does  when  the  good  that 
it  does  is  very  evident  indeed. 

A  patient  has  gastric  cancer.  He  is 
told  that  he  has  neuralgia  of  the  stomach, 
and  feels  greatly  relieved  by  the  reassur- 
ance, for  the  effect  of  psychic  influences  is 
nowhere  more  striking  than  in  gastric 
cancer  ( as  the  cases  quoted  in  Osier's  text- 
book show) .  Meantime  the  truth  is  told  to 
the  patient's  wife,  and  she  makes  whatever 
preparations  are  necessary  for  the  inevi- 
table end.    Now  what  harm  can  be  done 


THE  ART  OF  HEALING  139 

by  such  a  Ke  as  this  ?  The  sufferer  is  pro- 
tected from  anticipations  and  forebodings 
which  are  often  the  worst  portion  of  his 
misery,  while  his  wife,  knowing  the  truth 
and  thoroughly  approidng  of  the  decep- 
tion, is  able  to  see  that  her  husband's  fi- 
nancial affairs  are  straightened  out  and 
to  prepare,  as  well  as  may  be,  for  his 
death.  Surely  this  seems  a  humane  and 
sensible  way  to  ease  the  patient's  hard 
path,  and  who  can  be  the  worse  off 
for  it? 

I  answer,  "  Many  may  be  worse  off  for 
it,  and  some  must  be."  The  patient  himself 
is  very  possibly  saved  some  suffering. 
But  consider  a  minute.  His  wife  has  now 
acquired,  if  she  did  not  have  it  already,  a 
knowledge  of  the  circumstances  under 
which  doctors  think  it  merciful  and  useful 
to  lie.  She  will  be  sick  herself  some  day, 
and  when  the  doctors  tell  her  that  she  is 
not  seriously  ill,  is  she  likely  to  believe 
them? 


140  SOCIAL  SERVICE  AND 

I  was  talking  on  tliis  subject  not  long 
ago  with  a  girl  of  twenty-two.  "  Oh,  of 
course,  I  never  believe  what  doctors  say," 
was  her  comment,  "  for  I've  helped  'em  lie 
too  often  and  helped  fix  up  the  letters  that 
were  written  so  that  no  one  should  suspect 
the  truth." 

In  other  words  such  lies  simply  transfer 
to  the  future  accomit  of  one  person,  the 
sufferings  wliich  we  spare  another.  We 
rob  Peter  to  pay  Paul. 

But  it  is  not  likely  that  the  miscliief  ^dll 
be  so  closely  limited.  There  are  almost  al- 
ways other  members  of  the  family  who  are 
let  into  the  secret;  servants,  nurses,  and 
intimate  friends,  either  before  or  after  the 
patient's  death,  find  out  what  is  going 
on.  All  told,  I  doubt  if  there  are  less  than 
a  dozen  souls  on  the  average  who  are  en- 
lightened by  such  a  case  in  regard  to  the 
standards  of  the  physician  in  charge  and 
so  of  the  profession  he  represents.  I  have 
heard  such  tilings  talked  over  among  "  the 


THE  ART  OF  HEALING  141 

laity,"  and,  as  a  rule,  not  one,  but  several 
cases  are  adduced  to  exemplify  the  pre- 
vailing customs  of  medical  men  in  such 
circumstances. 

We  think  we  can  isolate  a  lie  as  we  do  a 
case  of  smallpox,  and  let  its  effect  die 
with  the  occasion  that  brought  it  about. 
But  is  it  not  common  experience  that  such 
customs  are  infectious  and  spread  far  be- 
yond our  intention  and  our  control  ?  They 
beget,  as  a  rule,  not  any  acute  indignation 
among  those  who  get  wind  of  them  (for 
"  how,"  they  say,  "  could  the  doctor  do 
otherwise"),  but  rather  a  quiet,  chronic 
incredulity  which  is  stubborn  just  in  pro- 
portion as  it  is  vitally  important  in  a  given 
case  to  get  at  the  truth,  as  in  the  case  of 
King  Edward  before  mentioned. 

You  will  notice  that  I  am  not  now  argu- 
ing that  a  He  is,  in  itself  and  apart  from  its 
consequences,  a  bad  thing.  I  am  not  say- 
ing that  we  ought  to  tell  the  truth  in  order 
to  save  our  own  souls  or  keep  ourselves 


142  SOCIAL  SERVICE  AND 

untainted.  I  am  saying  that  many  a  lie 
saves  present  pain  at  the  expense  of 
greater  future  pain,  and  that  if  we  saw 
as  clearly  the  future  harm  as  we  see  the 
present  good,  we  could  not  help  seeing 
that  the  balance  is  on  the  side  of  harm. 
Only  intellectual  short-sightedness  bHnds 
us  to  this. 

I  have  told  fully  my  share  of  hes,  under 
the  impression,  shared,  I  think,  by  many 
of  the  profession,  that  it  is  necessary  in  ex- 
ceptional cases  to  do  it  for  the  good  of  the 
patient  and  his  friends;  but  since  I  have 
been  experimenting  with  the  policy  of 
telling  the  truth  (at  first  cautiously,  but 
lately  with  more  confidence),  I  have  be- 
come convinced  that  the  necessity  is  a 
specious  one,  that  the  truth  w^orks  better 
for  all  concerned,  not  only  in  the  long  run, 
but  in  relatively  short  spurts,  and  that  its 
good  results  are  not  postponed  to  eternity, 
but  are  usually  discernible  within  a  short 
time. 


THE  ART  OF  HEALING  143 

In  vindication  of  my  belief  let  me  relate 
the  sequel  to  one  of  the  stories  already 
told.  The  reader  will  recall  that  I  pre- 
pared "to  be  very  guarded  in  what  I 
said  "  (as  the  technical  phrase  is)  to  a 
lady  whose  husband  had  angina  pectoris. 
The  attending  physician,  who  had  known 
the  lady  for  years,  and  who  represented 
entirely  the  views  of  her  family,  assured 
me  that  she  was  too  dehcate  and  too  un- 
strung by  neurasthenia  to  be  capable  of 
bearing  the  truth  about  her  husband.  If 
she  knew  that  he  might  at  any  time  die 
suddenly,  she  would  brood  and  fret  over 
the  knowledge  until  she  became  so  queru- 
lous and  unhinged  that  all  the  family,  the 
sick  husband  included,  would  be  made  mis- 
erable. It  will  be  remembered  that  I  made 
up  my  mind  to  conceal  the  truth  from  her 
if  I  could,  and  how  she  upset  all  my  cal- 
culations by  asking  me  suddenly  whether 
or  not  I  would  tell  her  the  whole  truth  so 
far  as  I  knew  it. 


144  SOCL\L  SERVICE  AND 

Xow  consider  a  moment  the  difficulties 
of  that  situation. 

"  Will  you  give  me  a  true  answer  to 
every  question  I  ask  you? "  I  could 
scarcely  be  expected  to  pop  out  a  prompt 
"  yes  "  when  I  had  just  promised  the 
family  physician  not  to  do  anytliing  of  the 
sort.  Of  course  I  could  not  say  "  no,"  and 
if  I  hesitated  an  instant,  I  had  betrayed 
my  intention  of  decei^dng  her.  What 
would  you  have  done  ? 

As  a  matter  of  fact  I  hesitated  a  bit, 
as  I  tliink  an^^one  but  a  most  practiced 
liar  or  a  liide-bound  truth-teller  would 
have  done.  "  That's  enough,"  said  she; 
"  that's  all  I  want  to  hear."  But  of  course 
I  couldn't  leave  it  there,  so  I  pulled  my- 
self together  and  made  a  clean  breast  of. 
the  whole  tMng.  I  told  her  just  what  I 
thought  and  what  I  expected,  including 
all  that  I  had  promised  the  doctor  not  to 
tell.  Xow  you  will  remember  that  the  at- 
tending physician,   who  had  known  her 


THE  ART  OF  HEALING  145 

intimately  for  years,  had  warned  me  that 
she  could  not  bear  this  sort  of  news — 
that  she  would  brood  and  worry  over  it, 
until  she  had  made  herself  and  everyone 
else  in  the  house  miserable.  So  when  she 
cornered  me  and  got  the  truth  out  of  me, 
I  made  haste  to  get  out  of  the  house,  and 
thanked  my  stars  that  I  did  not  have  to 
stay  behind  and  pick  up  the  pieces  of  the 
nervous  wreck  to  which  my  plain,  unvar- 
nished tale  must  needs  reduce  the  poor 
lady. 

Several  weeks  after,  I  met  the  family 
physician  and  learned  that  for  some  mys- 
terious reason  the  expected  collapse  on  the 
part  of  the  neurotic  wife  had  never  ar- 
rived. Everyone  was  still  expecting  her 
to  go  to  pieces,  but  as  yet  she  had  got 
along  about  as  usual.  In  point  of  fact  she 
has  never  met  their  expectation.  It  is 
now  nearly  fourteen  years  since  the  dread- 
ful truth  was  told  her  and  no  breakdown 
has  occurred. 


146  SOCIAL  SERVICE  AND 

After  that  most  astonishing  experience 
I  began  cautiously  to  tell  the  truth  in 
similar  cases,  even  though  intimate  friends 
or  relations  of  the  patient  declared  that 
the  truth  could  not  be  borne,  and  even 
when  I  had  no  knowledge  of  the  patient's 
character  to  set  against  that  of  his  closest 
friends.  It  has  been,  on  the  whole,  the 
most  interesting  and  surprising  experi- 
ment that  I  have  ever  tried.  The  astound- 
ing innocuousness  of  the  truth  when  all 
reason  and  all  experience  would  lead  one 
to  believe  it  must  do  harm,  has  never 
ceased  to  surprise  me.  It  seems  as  if  when 
the  pinch  comes  and  the  individual  has  to 
face  stern  realities,  some  species  of  anti- 
toxin is  spontaneously  and  rapidly  de- 
veloped whereby  the  individual  is  rendered 
immune  to  the  toxic  and  deleterious  effects 
of  the  nervous  shock ! 

May  we  not  conceive  that  under  the 
stimulus  of  the  first  sting  and  nettle  of 
hard  truth,  the  nervous  system  of  the  pa- 


THE  ART  OF  HEALING  147 

tient  produces  rapidly  an  overplus  of 
fighting  courage — rises  to  the  emergency, 
as  we  ordinarily  say,  and  so  is  rendered 
immune  against  the  otherwise  depressing 
effects  of  full  knowledge? 

But  whatever  the  theory,  the  fact  has 
been  brought  home  to  me  as  it  can  only  be 
brought  home  by  actually  trying  the  ex- 
periment; the  fact,  namely,  that  patients 
and  patients'  friends  exhibit  an  astonish- 
ing power  to  stand  the  full  truth,  an  amaz- 
ing immunity  against  its  depressing  de- 
fects. No  one  ought  to  beheve  this  who 
has  not  tried  it.  All  that  my  say-so  ought 
to  accomplish  is  to  make  someone  ready  to 
try  the  experiment ;  to  take  the  risks  which 
we  must  always  face  if  we  are  to  get  ahead, 
and  see  whether  he  can  verify  my  findings. 

One  precaution,  however,  must  be  borne 
in  mind.  Anyone  who  is  familiar  with  ex- 
perimental work  knows  that  the  difiiculty 
of  verifying  another's  experiment  is  often 
due  to  failure  to  repeat  just  that  experi- 


148  SOCIAL  SERVICE  AND 

ment  and  no  other.  A  certain  blood-stain 
is  highly  lauded.  Others  try  it  and  can- 
not get  the  results  which  its  inventor  claims 
for  it.  But  very  often  they  fail  because 
they  have  not  followed  exactly  the  details 
of  the  inventor's  technic. 

So,  if  anyone  tries  to  repeat  my  experi- 
ments I  trust  that  he  will  notice  just  what 
it  is  that  I  recommend  him  to  try.  I  am 
not  saying  that  a  doctor  should  explain  to 
eveiy  mother  in  full  detail  the  cause,  symp- 
toms, course,  and  prognosis  of  her  baby's 
illness.  I  have  never  tried  that  experi- 
ment, and  I  should  suppose  it  would  be 
a  very  stupid,  useless,  and  probably  harm- 
ful thing  to  do.  I  do  not  believe  in  cram- 
ming information  down  people's  throats 
or  trying  to  tell  them  what  they  cannot 
understand  properly,  any  more  than  I  be- 
lieve in  button-holing  every  acquaintance 
in  the  street,  and  giving  him  a  detailed 
account  of  what  I  consider  his  faults  and 
failings. 


THE  ART  OF  HEALING  149 

But  if  my  friend  asks  me  for  an  opinion 
of  his  first  literary  productions,  and  if  I 
think  that  they  are  dreadful  rubbish,  I  do 
not  consider  it  friendship  to  say  pleasant 
tilings  of  his  style  and  thereby  encourage 
him  to  pursue  literature  as  a  calhng.  I 
do  not  give  my  opinion  unless  it  is  really 
asked  for.  But  if  it  is,  I  do  not  beheve  in 
lying  to  save  anyone's  feehngs.  It  does 
more  harm  and  bruises  more  feelings  in  the 
end. 

So  in  medicine,  if  a  patient  asks  me  a 
straight  question  I  believe  it  works  best  to 
give  him  a  straight  answer,  not  a  rough 
answer,  but  yet  not  a  lie  or  a  prevarica- 
tion. I  do  not  believe  it  pays  to  give  an 
answer  that  would  justify  a  patient  in 
saying  (in  case  he  happened  to  find  out  the 
truth) — "  That  doctor  tried  to  trick  me." 
I  have  heard  a  patient  say  that,  apropos  of 
a  lie  told  by  one  of  the  most  high-minded 
and  honorable  physicians  I  know,  and  I 
do  not  believe  it  advisable  for  any  of  us 


150  SOCIAL  SERVICE  AND 

to  expose  ourselves  to  the  chance  of  rous- 
ing that  sort  of  indignation  in  a  patient. 

A  straight  answer  to  a  straight  question 
is  what  I  am  recommending,  not  an  un- 
asked presentation  of  any  of  the  facts  of 
the  patient's  case.  He  may  not  care  to 
know  those  facts  any  more  than  I  care  to 
know  the  interesting  details  of  dental 
pathology  in  which  my  dentist  might  wish 
to  instruct  me;  I  prefer  to  leave  all  that 
to  him.  Just  so  my  patient  may  very 
properly  prefer  to  be  told  nothing  about 
his  disease,  trusting  that  I  shall  do  my 
best  and  let  him  know  when  there  is  any- 
thing for  him  to  do  in  the  matter. 

But  a  straight  answer  does  not  mean 
what  is  often  called  the  "  blunt  truth,"  the 
"  naked  truth,"  the  dry,  cold  facts.  Verac- 
ity means  (as  I  have  said)  the  attempt  to 
convey  a  true  impression,  a  fully  drawn 
and  properly  shaded  account  such  as  is, 
as  I  well  know,  very  difficult  to  give.  I 
know  one  physician  (and  a  splendid  type 


THE  ART  OF  HEALING  151 

of  man  he  is,  too)  who,  when  he  sees  a 
case  of  rheumatic  heart  trouble,  and  is 
asked  for  a  prognosis,  is  apt  to  say  some- 
thing hke  this:  "  Well,  I'm  mighty  sorry 
for  you,  but  your  trouble  is  incurable. 
Your  heart  is  damaged  past  repair  and 
there  is  not  much  of  anything  to  be  done 
except  to  take  sodium  sahcylate  during  the 
acute  attacks  and  hope  that  the  process 
will  become  arrested  spontaneously  before 
long."  "  Is  it  likely  to  get  worse?  "  asks 
the  patient.  "  Yes,  I'm  afraid  that 
it  is." 

.  Now  in  one  sense  that  is  all  true,  but 
the  impression  that  it  will  convey  to  the 
patient  is  not  true,  not  at  all  what  I  mean 
by  veracity.  I  would  rather  a  physician 
would  tell  this  sort  of  truncated,  imper- 
fect, and  very  distressing  truth,  than  give 
the  patient  a  smooth  and  pleasant  assur- 
ance that  he  can  be  cured  and  that  all  will 
go  right  provided  he  does  so  and  so. 

But  better  than  either  a  misleading  half- 


152  SOCIAL  SERVICE  AND 

truth  or  a  pleasing  Ke,  is  an  attempt  so  to 
answer  the  patient's  question  that  he  shall 
see  not  only  what  he  can't  do  and  can't 
hope  for,  but  what  he  can  do  and  what 
there  is  to  work  for  hopefully.  That  his 
heart-valve  is  leaky  and  perhaps  useless 
is  true,  and  in  that  sense,  to  that  extent, 
he  is  incurable;  the  damaged  heart-valve 
is  damaged  once  for  all.  Yet  by  ac- 
commodating himself  to  liis  diminished 
heart  power,  the  patient  can  gradually 
educate  to  a  considerable  extent  both  his 
heart  and  the  rest  of  himself.  His  heart 
can  be  made  to  adjust  itself  to  its  maimed 
state  and  to  put  forth,  in  spite  of  it,  a  good 
deal  more  power  than  it  would  have  done 
without  the  educational  process;  and  the 
indi^ddual,  by  learning  to  take  the  best 
advantage  of  all  the  power  he  has,  can 
accomplish,  not  all  that  he  could  in  health, 
but  yet  perhaps  as  much  as  he  actually 
would  have  done,  allowing  for  the  amount 
of  wasted  time  and  w^asted  opportunity 


THE  ART  OF  HEALING  153 

that  has  often  to  be  deducted  from  the 
effective  power  of  a  healthy  man. 

Because  this  kind  of  explanation  is  so 
difficult  and  takes  so  much  time,  doctors 
are  apt  to  shirk  it  and  give  the  patient 
either  a  rough  half-truth  or  a  smooth  lie. 
In  our  free  dispensaries  one  can  witness 
any  day  a  rich  and  varied  assortment  of 
these  two  methods  of  shirking  a  difficult 
and  tedious  explanation;  the  rough  half- 
truth  and  the  smooth  lie  are  dealt  out  by 
the  shovelful  and  students  watch  and  make 
their  choice  between  these  two  pitiful 
makeshifts  according  to  their  tempera- 
ments, often  in  entire  ignorance  of  any 
tertium  quid.  For  it  is  particularly  in 
dealing  with  uneducated  people,  such  as 
frequent  dispensaries,  that  we  distrust  the 
power  of  truth  and  the  possibility  of  con- 
veying it.  In  this  field  I  have  made  many 
experiments  both  with  hes  and  with  the 
truth.  I  know  very  well  that  the  truth 
is  sometimes  next  to  impossible  to  convey, 


154  SOCIAL  SERVICE  AND 

owing  to  differences  between  the  patient's 
vocabulary  (or  his  habits  of  mind)  and  the 
physician's,  but  on  the  other  hand  the  lie 
may  do  more  harm,  for  there  is  more 
chance  of  its  being  implicitly  believed. 

To  refuse  to  answer  questions  is  now 
and  then  a  necessity  and  need  not  involve 
any  falsehood.  For  example,  to  balk  med- 
dhng  inquiries  by  an  outsider  is  often  our 
business.  Then  there  is  the  patient  about 
to  undergo  an  operation,  who  sometimes 
catecliizes  us  about  the  details  of  the  opera- 
tion, though  he  had  better  remain  ignorant 
about  it  until  after  it  is  over.  On  the  other 
hand,  if  the  patient's  mind  is  already  oc- 
cupying itself  with  a  definite,  but  exag- 
gerated picture  of  the  horrors  of  the 
operation,  a  prosaic  explanation  of  the 
real  facts  may  act  as  a  sedative. 

Not  infrequently  we  need  to  choose  our 
time  well,  if  a  piece  of  painful  truth  has 
to  be  communicated,  and  it  may  be  neces- 
sary to  avoid  giving  the  patient  a  chance 


THE  ART  OF  HEALING  155 

to  cross-question  us  at  a  time  when  we 
consider  him  temporarily  helow  par.  I 
have  heard  a  patient  say:  "  The  doctor 
didn't  mean  to  let  me  get  that  out  of  him 
to-day,"  but  it  was  said  without  any  bit- 
terness or  sense  of  being  tricked  by  his 
physician,  for  the  fact  that  the  doctor 
avoided  being  questioned  presaged  that,  if 
cornered,  he  would  not  tell  a  lie. 

I  have  said  that  in  my  experience  pa- 
tients and  their  families  often  develop  a 
most  astonishing  power  to  rise  to  the 
emergency  and  to  bear  the  hard  truth 
when  it  has  to  be  told.  But  I  cannot  say 
that  this  is  always  so.  There  may  be  cases, 
I  suppose  there  are  such,  when  the  patient 
does  not  react  from  the  shock  of  a  cruel 
truth,  but  is  made  worse  by  it.  It  is  said 
that  such  a  shock  sometimes  turns  the 
scales  and  brings  death.  I  have  never  seen 
this  happen,  but  I  cannot  deny  the  possi- 
bihty. 

Ought  we  to  persist  in  teUing  the  truth 


156  SOCIAL  SERVICE  AND 

even  when  we  know  that  it  may  kill  the  pa- 
tient? Could  any  effect  produced  by  a  he 
be  as  bad  as  the  loss  of  a  human  hfe? 

Before  answering  this  question  directly, 
let  me  ask  you  to  consider  a  somewhat 
fanciful  hypothesis.  Suppose  it  lay  in 
our  power  to  let  loose  into  the  atmosphere 
a  poisonous  gas,  which  would  vitiate  the 
air  of  a  whole  town  so  that  the  whole  com- 
munity would  gradually  suffer  in  effi- 
ciency, in  physical  and  moral  fiber.  Would 
it  not  be  worth  sacrificing  a  human  life 
to  save  a  whole  community  from  such 
deterioration? 

Now  a  lie  seems  to  me  to  do  something 
like  that.  By  undermining  the  confidence 
of  man  in  man  it  does  its  part  in  making 
not  one  but  every  human  activity  impos- 
sible. If  we  cannot  trust  one  another,  we 
cannot  take  a  step  in  any  direction.  Busi- 
ness, social  relations,  science,  everything 
worth  doing  depends  on  mutual  con- 
fidence.   It  is  the  very  air  we  breathe.    To 


THE  ART  OF  HEALING  157 

poison  it  is  to  do  a  thing  far  worse  for  so- 
ciety than  the  loss  of  a  single  life.  Hence 
though  I  believe  that  it  is  extraordinarily 
rare  to  be  able  to  save  a  life  by  a  lie,  it 
seems  to  me  that  the  remedy,  the  lie,  is 
worse  than  death. 

Ill 

Truth  and  Falsehood  in  Treatment 

In  discussing  truth  and  falsehood  in 
diagnosis  and  in  prognosis,  I  have  dealt 
chiefly  with  spoken  truth  or  spoken  lies. 
In  the  domain  of  treatment  the  true  or 
false  impression  is  often  conveyed  without 
words. 

I  do  not  know  who  it  was  that  defined  a 
quack  as  "  one  who  pretends  to  possess  or 
to  be  able  to  use  powers  (either  of  diag- 
nosis, prognosis,  or  treatment)  which  in 
fact  he  knows  he  is  without."  If  we  think 
over  the  various  forms  of  quacks  familiar 
to  us — Dr.  Munyon,  with  his  lifted  hand 
swearing  to  the  value  of  all  those  specific 


158  SOCIAL  SERVICE  AND 

cures  which  he  knows  he  does  not  possess ; 
the  cancer  curers,  those  who  advertise  to 
cure  "  weak  men,"  Francis  Truth,  who 
cheats  his  dupes  with  all-heaHng  handker- 
chiefs sent  through  the  mails  at  $5  apiece 
— we  see  that  they  all  pretend  to  use 
knowledge  about  valuable  medicines  or 
other  remedies  which  they  know  are 
frauds. 

Now,  I  was  brought  up,  as  I  suppose 
every  physician  is,  to  use  what  are  called 
placebos,  that  is  bread  pills,  subcutaneous 
injections  of  a  few  drops  of  water  (sup- 
posed by  the  patient  to  be  morphine) ,  and 
other  devices  for  acting  upon  a  patient's 
symptoms  through  his  mind.  How  fre- 
quently such  methods  are  used  varies  a 
great  deal  I  suppose  with  individual  prac- 
titioners, but  I  doubt  if  there  is  a  physician 
in  tliis  country  who  has  not  used  them  and 
used  them  pretty  often.  It  never  occurred 
to  me  until  I  had  given  a  great  many 
"  placebos  "  that,  if  they  are  to  be  really 


THE  ART  OF  HEALING  159 

effective,  they  must  deceive  the  patient.  I 
had  thought  of  them  simply  as  a  means  of 
getting  rid  of  a  symptom  and  no  more  a 
lie  than  hypnotism  or  any  other  form  of 
frankly  mental  therapeutics. 

But  one  day  a  patient  caught  me  in  the 
attempt  to  put  her  to  sleep  by  means  of  a 
subcutaneous  injection  of  water.  "  I  saw 
you  get  that  ready,"  said  she,  "  and  there 
is  no  morpliin  in  it;  you  were  just  trjdng 
to  deceive  me."  I  was  fairly  caught  and 
there  was  no  use  in  trying  to  bluif  it  out, 
so  I  merely  protested  that  my  deception 
was  well  meant,  that  it  profited  me  noth- 
ing, that  it  was  simply  intended  to  give 
her  a  night's  rest  without  the  depressing 
effects  of  morphia,  etc. 

"  Of  course  I  see  that,"  she  said,  "  but 
how  am  I  to  know  in  future  what  other 
tricks  you  will  think  it  best  to  play  me  for 
my  good?    How  am  I  to  beheve  anything, 
you  say  from  now  on?  " 

I  did  not  know  what  answer  to  make  at 


160  SOCIAL  SERVICE  AND 

the  time,  and  I  have  never  been  able  to 
tliink  of  any  since. 

But  water  subcutaneously  does  not  dif- 
fer in  principle  from  any  other  placebo. 
If  the  patient  knows  what  we  are  up  to 
when  we  give  him  a  bread  pill  it  will  have 
no  effect  on  him.  If  he  is  dyspeptic  he 
must  believe  that  we  consider  the  medicine 
we  give  likely  to  act  upon  his  stomach  and 
not  merely  upon  Ms  stomach  through  his 
mind.  Otherwise  it  will  do  him  no  good. 
Suppose  we  said  to  him:  "  I  give  you  this 
pill  for  its  mental  effect.  It  has  no  action 
on  the  stomach  " ;  would  he  be  likely  to  get 
benefit  from  it?  No,  it  is  only  when 
through  the  placebo  one  deceives  the  pa- 
tient that  any  effect  is  produced.  It  is 
only  when  we  act  like  quacks  that  our 
placebos  work. 

But  what  harm,  one  may  ask,  does  a 
placebo  do?  Admitting  that  it  is  a  form 
of  deception  and  that  if  a  doctor  is  de- 
tected in  it  the  patient  and  his  friends  are 


THE  ART  OF  HEALING  161 

likely  to  lose  confidence  in  him,  what  harm 
does  it  do,  so  long  as  you  are  not  found 
out? 

Well,  as  previously  said,  I  do  not  think 
it  is  a  good  thing  for  any  man  to  succeed 
only  so  long  as  he  is  not  found  out,  but 
there  are  other  objections  to  the  use  of 
placebos  which  I  will  next  try  to  explain. 

The  majority  of  placebos  are  given  be- 
cause we  beHeve  the  patient  will  not  be 
satisfied  without  them.  He  has  learned  to 
expect  medicine  for  every  symptom,  and 
without  it  he  simply  won't  get  well.  True, 
but  who  taught  him  to  expect  a  medicine 
for  every  symptom?  He  was  not  born 
with  that  expectation.  He  learned  it 
from  an  ignorant  doctor  who  really  be- 
lieved it,  just  as  he  learned  many  old 
legends,  as,  for  example,  that  pimples  are  a 
disease  of  the  blood,  that  "  shingles  "  kills 
the  patient  whenever  it  extends  clear  round 
the  body,  and  that  in  the  spring  the  blood 
should   be    "  purified "    by   this    or   that 


162  SOCIAL  SERVICE  AND 

remedy.  It  is  we  physicians  who  are  re- 
sponsible for  perpetuating  false  ideas 
about  disease  and  its  cure.  The  legends 
are  handed  along  through  nurses  and  fond 
mothers,  but  they  originate  with  us,  and 
with  every  placebo  that  we  give  we  do  our 
part  in  perpetuating  error,  and  harmful 
error  at  that.  If  the  patient  did  not  ex- 
pect a  medicine  for  liis  attack  (say  of 
mumps)  we  should  not  give  it,  yet  w^e  do 
all  we  can  to  bolster  up  liis  expectation  for 
another  time,  to  deepen  the  error  we  de- 
plore. 

Some  years  ago  an  unfortunate  patient 
was  floating  around  from  one  chnic  to 
another,  as  happens  now  and  then  w^hen 
diagnosis  and  treatment  are  unsuccessful. 
Tliis  poor  woman  complained  that  she  had 
a  hzard  in  her  stomach,  that  she  felt  his 
movements  distinctly,  and  that  they  ren- 
dered her  life  unbearable.  Doctor  after 
doctor  had  assured  her  that  the  tiling  was 
impossible,  that  no  such  animal  could  sub- 


THE  ART  OF  HEALING  163 

sist  inside  a  human  being,  that  the  trouble 
was  wholly  a  fanciful  one,  and  that  she 
must  do  her  best  to  think  of  it  no  more. 
But  all  such  explanations  and  reassur- 
ances were  of  no  avail. 

One  evening  a  group  of  physicians  at  a 
small  medical  club  were  discussing  the 
nervous  affections  of  the  stomach,  with 
this  case  as  a  text.  Then  up  spoke  one 
of  the  elder  of  the  number  had  said,  "  I'll 
B.X  that  woman ;  you  send  her  to  me !  "  So 
said,  so  done.  The  unfortunate  female 
appeared  at  his  clinic  within  a  few  days. 
Our  friend  the  doctor  listened  with  great 
attention  to  all  her  symptoms,  nodding  his 
head  gravely  from  time  to  time.  He  en- 
tered a  lengthy  account  of  the  case  upon 
his  records,  and  meditated  sagely  for  a 
time  when  she  had  finished.  "  Yes,"  he 
said,  with  a  sigh,  "  there  is  no  doubt  about 
it ;  it's  a  clear  case  of  hzard  in  the  stomach. 
It  is  no  use  concealing  the  truth  from  you 
any  longer;  you  have  every  symptom  of 


164  SOCIAL  SERVICE  AND 

the  disease.  But  we  have  made  a  good 
deal  of  progress  within  the  last  few 
months,  Madam,  in  the  treatment  of  that 
trouble,  and  while  I  cannot  make  any 
promises  (for  no  honorable  doctor  can  do 
any  tiling  of  that  kind) ,  I  think  I  can  give 
you  good  hope  that  you  may  be  relieved. 
A  medicine  has  recently  been  discovered 
which,  in  the  majority  of  cases, — not  all 
cases,  mind  you — will  dissolve  hzards  in 
the  stomach  and  allow  the  resulting  sub- 
stance to  be  excreted  by  the  kidney.  As 
I  say.  Madam,  I  cannot  promise  a  cure, 
but  this  I  can  promise: — within  a  few 
days  after  you  have  taken  my  medicine 
you  will  be  absolutely  sure  whether  or  not 
it  has  proved  effective.  In  case  it  should 
prove  effective,  you  will  notice  within 
forty-eight  hours  from  the  time  you  take 
it  an  extraordinary  change  in  the  color  of 
your  urine,  wliich  will  be  tinged  some 
shade  of  blue,  or  bright  green.  In  case 
the  medicine  fails,  as  is  quite  possible  that 


THE  ART  OF  HEALING  165 

it  may,  there  will  be  no  change  whatever 
in  the  color  of  the  urine.  The  medicine 
will  be  contained  in  three  capsules,  for 
which  I  have  just  written  a  prescription; 
they  can  be  obtained  only  at  one  apothe- 
cary's in  the  city,  as  the  medicine  is  diffi- 
cult to  procure  and  known  to  but  few.  I 
have  written  his  address  on  the  prescrip- 
tion." 

The  doctor  then  handed  her  a  prescrip- 
tion for  three-grain  capsules  of  Methylene 
Blue,  a  substance  which,  when  taken 
into  the  stomach,  invariably  produces  a 
deep  blue  color  in  the  urine.  The  woman 
took  the  medicine,  perceived  to  her  amaze- 
ment and  delight  that  a  blue  color  was  im- 
parted to  her  urine,  recognized  that  the 
lizard  must  have  been  dissolved,  and  was 
at  once  freed  from  all  her  symptoms. 

Now,  this  is  the  end  of  the  story  as  it  is 
usually  told ;  but  there  is  a  sequel.  Within 
the  course  of  three  months  another  Kzard 
grew.     This  time  the  poor  lady  had  no 


166  SOCIAL  SERVICE  AND 

more  faith  in  Methylene  Blue  as  a  per- 
manent cure,  and  turned  up  at  still  an- 
other Out-Patient  clinic  under  the  charge 
of  a  very  honest  physician,  to  whom  she 
told  her  story.  He  said  of  course  that 
it  was  ridiculous  and  impossible,  because 
lizards  couldn't  grow  in  people's  stomachs. 
"  Oh,"  she  said,  "  you  know  Doctor  Blank, 
don't  you?  He  is  a  good  doctor,  isn't 
he?  "  "  Yes."  "  Well,  he  told  me  I  had 
all  the  symptoms  of  lizard  in  the  stomach. 
He  wouldn't  tell  me  a  lie,  would  he?  "  . 
"  Well,  anyway,  you  haven't  got  a  liz- 
ard in  your  stomach  now."  From  this  the 
doctor  went  one  step  further  than  anyone 
had  gone  before;  he  investigated  not  only 
what  was  not  the  matter  with  her,  but 
what  the  trouble  actually  was.  He  found 
that  she  had  an  excess  of  gastric  juice  in 
her  stomach,  the  irritation  of  which  gave 
the  gnawing  and  scratching  feeling  which 
she  attributed  to  the  presence  of  a  lizard. 
Having  discovered  this  fact  he  proceeded 


THE  ART  OF  HEALING  167 

to  treat  her  for  this  trouble,  which  he  suc- 
ceeded in  curing,  and  after  that  time  the 
hzard  never  grew  again.  All  of  which 
shows  that  lies  do  not  always  work,  and 
that  the  truth  sometimes  does. 

Placebos  with  or  without  lies  are  un- 
necessary. I  have  for  the  past  few  years 
been  trying  the  experiment  of  explaining 
to  the  patient  why  he  does  not  need  a 
drug,  when  there  is  no  drug  known  for  his 
trouble.  It  takes  a  little  more  time  at 
first,  but  one  thorough  explanation  serves 
for  many  subsequent  occasions.  One  has 
only  to  remind  the  patient  of  what  we  have 
gone  over  with  him  before.  When  the  oc- 
casion for  a  drug  really  comes,  the  patient 
has  far  more  confidence  in  its  workings. 

We  doctors  feel  these  things  acutely 
when  a  patient  comes  to  us  who  has  been 
previously  under  the  care  of  another 
physician  who  educates  his  patients.  How 
refreshing  to  hear  the  mother  of  a  child 
sick  with  measles  say,  "  Well,  I  don't  sup- 


168  SOCIAL  SERVICE  AND 

pose  he  needs  any  medicine,  does  he  ?  The 
disease  has  to  run  its  course,  I  suppose, 
and  nursing  is  the  main  thing."  That 
mother  has  been  given  the  truth  by  her 
physician  instead  of  placebos,  and  has 
become  accustomed  to  reahties  as  easily  as 
most  people  learn  to  believe  outworn 
errors.  On  the  other  hand,  we  see  now  and 
then  a  patient  into  whose  mind  it  has  been 
carefully  instilled  by  some  physician  that 
every  draught  of  fresh  air  must  be  avoided 
hke  a  plague,  that  every  symptom  needs 
a  drug,  and  that  a  visit  from  the  doctor 
every  few  days  is  a  necessity  to  salvation. 
But  the  habit  of  giving  placebos  has  an- 
other evil  result.  It  gives  the  patient  in- 
directly a  wrong  idea,  a  harmful  idea  of 
the  way  disease  is  produced  and  avoided. 
If  symptoms  can  be  cured  by  drugs,  it  is 
impossible  to  bring  to  bear  upon  the  pa- 
tient the  full  force  of  that  most  funda- 
mental principle  of  therapeutics:  "  To  re- 
move a  symptom  remove  its  cause."    That 


THE  ART  OF  HEALING  169 

a  man  can  be  made  well  "  in  spite  of  him- 
self "  as  the  patent -medicine  advertise- 
ments say  (that  is,  in  spite  of  ^dolating  the 
laws  of  health)  is  a  belief  produced  as  one 
of  the  by-products  of  the  way  w^e  hand 
out  placebos,  especially  in  our  hospitals 
and  dispensaries.  Thus  we  foster  the 
patent-medicine  habit. 

No  patient  whose  language  we  can 
speak,  whose  mind  we  can  approach,  needs 
a  placebo.  I  give  placebos  now  and  then 
(I  used  to  give  them  by  the  bushel)  to 
Armenians,  Greeks,  and  others  with  whom 
I  cannot  conmiunicate,  because  to  refuse 
to  give  them  would  then  create  more  mis- 
understanding, a  falser  impression,  than  - 
to  give  them.  If  I  give  nothing  at  all  the 
patient  will  think  I  am  refusing  to  treat 
him  at  all;  but  if  I  can  get  hold  of  an  in- 
terpreter and  explain  the  matter,  I  tell 
him  no  lies  in  the  shape  of  placebos. 

Before  I  close  this  chapter  I  want  to 
speak  of  one  further  point  which  my  ex- 


170  SOCIAL  SERVICE 

periments  with  truth  and  falsehood  have 
brought  home  to  me.  When  I  have 
plucked  up  courage  and  ventured  to  tell 
the  truth  in  hard  cases,  I  have  been  sur- 
prised again  and  again  to  find  how  all  the 
chances  and  accidents  of  nature  have 
backed  me  up.  Everything  seems  to  con- 
spire to  help  you  out  when  you  are  trying 
to  tell  the  truth,  but  when  you  are  l}dng 
there  are  snares  and  pitfalls  turning  up 
everywhere  and  making  your  path  a  more 
and  more  difficult  one. 

I  will  sum  up  the  results  of  my  experi- 
ments with  truth  and  falsehood,  by  saying 
that  I  have  not  yet  found  any  case  in 
which  a  he  does  not  do  more  harm  than 
good,  and  by  expressing  my  belief  that 
if  everyone  will  carefully  repeat  the  ex- 
periments he  will  reach   similar  results. 

The  technic  of  truth-telling  is  sometimes 
difficult,  perhaps  more  difficult  than  the 
technic  of  lying,  but  its  results  make  it 
worth  acquiring. 


CHAPTER  V 

SOCIAL  WORK  IN  HOSPITALS;  THE  PALLIA- 
TION OF  ABSENT-MINDEDNESS 

Suppose  a  person  sharing  the  ideas  ex- 
pressed in  the  foregoing  chapters  were 
suddenly  and  for  the  first  time  in  his 
hfe  deposited  in  a  busy  hospital  clinic. 
Suppose  also  that  he  is  a  genius  and  can 
see  through  his  own  eyes,  as  the  rest  of 
us  rarely  do.  What  will  most  of  all  sur- 
prise him?  Not  the  rush  and  roar  of  it 
all.  That  he  is  used  to  wherever  Ameri- 
cans are  at  work.  Not  the  foul  air  and 
bad  smells.  He  has  learned  long  since 
that  the  practice  of  hygiene  is  for  other 
people,  not  for  ourselves  who  preach  it. 
Not  the  amazing  and  unnecessary  ugliness 
of  every  room  and  hall.  Rather  he  will 
be  arrested  by  the  astonishing  absent- 
mindedness  of  the  doctors. 

171 


172  SOCIAL  SERVICE  AND 

The  philosopher,  intent  upon  his  prob- 
lem, may  abstractedly  walk  over  a  preci- 
pice, but  I  never  heard  of  one  so  absent- 
minded  as  to  push  a  young  girl  over  a 
precipice  as  we  are  doing  every  month  in 
our  gynaecological  clinics.  Not  an  atom 
of  cruelty  or  hard-heartedness  about  it ; — 
purely  the  habit  of  abstraction,  the  habit 
of  saying,  "  My  job  ends  here." 

"  She  came  in  to  find  out  if  she  was 
pregnant.  I  told  her  '  Yes,'  and  she  went 
off.  Is  that  pushing  her  over  a  preci- 
pice? " 

Yes,  in  many  cases  it  is  just  that.  The 
doctor  is  so  absent-minded  that  he  doesn't 
notice  the  push  towards  hell  which  his 
word  all  innocently  gives  her.  "  Yes, 
you  are  now  cut  off  from  your  family, 
who  will  be  indignant  at  the  shame  you 
put  upon  them;  from  your  friends,  who 
will  no  longer  want  their  names  coupled 
with  yours.  You  will  be  branded  as 
'  fallen '  and  kindly  looked  down  on  by 


THE  ART  OF  HEALING  173 

those  who  have  fallen  perhaps  far  oftener 
than  you,  though  in  less  obvious  ways. 
Everyone  in  the  community  will  be 
against  you  except  the  keepers  of  the 
brothels.  You  cannot  longer  go  on  earn- 
ing an  honest  living,  for  if  you  try  to  do  so, 
your  condition  will  soon  be  observed.  If 
you  try  to  get  square  with  the  world  again 
by  killing  your  child  before  its  birth,  you 
will  run  a  considerable  danger  of  death 
by  blood-poisoning,  and  the  law  will  re- 
gard you  as  a  criminal  if  you  are  found 
out.  That  is  all  to-day; — step  into  the 
next  room,  please,  and  the  nurse  will  help 
you  to  dress." 

I  say — a  man  who  in  effect  gives  that 
message  to  a  girl  and  doesn't  notice  that 
he  has  done  so  is  wonderfully  absent- 
minded.  Methodically  his  mind  has 
passed  on  to  the  next  case,  to  the  steriliza- 
tion of  his  rubber  gloves,  to  the  record 
sheet  on  which  he  is  writing  his  diagnosis 
and  his  account  of  the  physical  examina- 


174  SOCIAL  SERVICE  AND 

tion.  He  is  absent-niinded  precisely  as  the 
mathematical  professor  or  the  pliilosopher 
is  absent-minded,  because  his  mind  is  so 
actively  present  somewhere  else.  The 
mathematician  is  not  vague  or  dreamy. 
He  is  abnormally  clear,  but  he  is  so  con- 
centrated and  speciahzed  upon  one  set 
of  problems  that  he  doesn't  notice  the 
rest  of  the  world.  So  the  doctor's  mind  is 
absent  from  certain  human  aspects  of  liis 
patients'  hves  merely  because  his  atten- 

tention  is  so  strongly  concentrated  upon 
disease. 

Now  it  is  always  dangerous  to  be  absent- 
minded.  It  is  risky  to  have  one's  head  so 
full  of  mathematics  as  to  ignore  physics 
and  fall  into  a  ditch,  to  become  so  absorbed 
in  profit  and  finance  as  to  allow  unpro- 
tected macliiner}"  to  maim  workmen,  to  be 
so  wrapped  up  in  Edd^dsm  as  to  catch  and 
spread  smallpox,  to  be  so  bent  on  good- 
fellowsliip  as  (absent-mindedly)  to  get 
drunk.     But  if  ever  there  was  a  place 


THE  ART  OF  HEALING  175 

where  absent-mindedness  is  dangerous  to 
life  and  limb,  to  soul  and  body, — that  place 
is  a  hospital. 

Why?  Because  its  contents  are  so  curi- 
ously assorted.  People  wander  in  there, 
— the  first  because  he  has  lost  his  money, 
and  the  next  because  he  has  lost  his  mind. 
The  third  needs  a  ham  spHnt,  the  fourth 
needs  a  husband  (who  has  deserted  her). 
One  wants  a  fortnight's  outing,  another 
wants  false  teeth  and  something  to  put 
between  them.  New  caution  with  the  cat 
(which  gives  ring- worm),  new  care  with 
the  cooking  (which  spoils  digestion),  new 
plaster  jackets  and  new  plans  of  action, — 
absolutely  we  can  see  no  end  to  the  variety 
of  need  that  pours  in  through  the  hospital 
gates  at  nine  and  pours  out  again  at 
noon  with  some  sort  of  patch  or  plaster 
on  it. 

Presence  of  mind,  presence  of  the  whole 
resources  of  the  best-trained  intellect,  we 
obviously  need  if  we  are  to  do  anything  for 


176  SOCLVL  SERVICE  AND 

this  miscellany  when  once  it  is  sorted  out. 
But  the  task  is  made  ten  times  harder, 
ten  times  more  of  a  Waterloo  for  the 
absent-minded,  by  the  fact  that  each  need 
comes  to  us  obscured  under  a  blinding 
dust-storm  of  understatement,  overstate- 
ment, misstatement,  and  omission.  The 
poor  folks  have  no  idea  what  they  need. 
They  know  that  they  are  off  the  track, — 
that's  all. 

The  need,  then,  is  for  all-round  human 
beings  who  can  supplement  the  necessary 
and  valuable  narrowness  of  the  physician. 
The  physician  is  there  because  he  has  , 
learned  a  great  deal  about  one  small  but 
vital  aspect  of  human  hfe, — learned  it  at 
the  expense  of  a  habit  of  \dolent  absent- 
mindedness  towards  other  aspects.  His 
value,  his  skill,  rest  on  this  concentration 
of  his.  But  with  the  painful  acquisition 
of  this  necessary  habit  of  abstraction  he 
becomes  a  dangerous  man,  just  as  the  law- 
yer, the  orator,  and  the  financier  are  dan- 


THE  ART  OF  HEALING  177 

gerous, — unless  supplemented  and  bal- 
anced. Abstractedly  he  will  give  an  ap- 
petizing, bitter  tonic  to  a  starving  man,  or 
break  up  a  family  some  crowded  Satur- 
day morning,  unless  there  is  help  at  hand. 

II 

There  is  a  vast  deal  of  work  in  a  hospital 
that  the  doctor  can't  do  and  doesn't  want 
to  do.  For  example, — he  has  neither  the 
time  nor  the  talent  to  teach  hygiene,  to  fit 
new  sets  of  habits  to  the  idiosyncrasies  of 
each  sufferer's  build.  Yet  without  hygiene 
most  of  medicine  is  useless,  and  without 
skillful  fitting  to  the  individual's  needs, 
hygienic  rules  are  simply  old  junk. 

Better  health  means  more  money  usu- 
ally;— in  consumption,  heart  disease, 
neurasthenia,  somebody  has  got  to  hustle 
for  some  money  if  the  doctor's  orders  are 
to  be  carried  out.  He  doesn't  want  to  go 
out  and  hustle  for  the  money,  but  neither 
does  he  care  to  whistle  to  the  wind,  or  give 


178  SOCIAL  SERVICE  AND 

orders  that  can't  be  carried  out.  To  order 
for  one  patient  a  diet  which  he  cannot  buy, 
for  the  next  a  vacation  which  he  is  too  poor 
to  take,  to  forbid  a  third  to  worry  when 
we  know  that  the  necessary  cause  of  worry 
remains  unchanged,  to  give  the  fourth  di- 
rections for  an  outdoor  hfe  which  we  are 
morally  certain  he  won't  carry  out,  to  try 
teaching  the  fifth  (a  Jewish  mother)  how 
to  modify  milk  for  her  baby,  when  she 
understands  perhaps  half  of  what  you  say 
and  forgets  most  of  that, — such  a  morn- 
ing's work  is  not  satisfactory  in  the  retro- 
spect. 

Therefore  to  make  the  doctor's  work 
worth  while  to  himself  and  to  the  patient, 
it  must  be  done  (in  hospitals)  in  co-opera- 
tion with  someone  who  has  time  and  ability 
to  teach  hygiene  and  to  see  that  it  is  car- 
ried out  (for  instance,  in  tuberculosis),  to 
study  the  home  conditions  and  report  upon 
their  part  in  causing  or  prolonging  dis- 
ease, and  to  help  modify  those  conditions, 


THE  ART  OF  HEALING  179 

financial,  mental,  moral,  which  stand  be- 
tween the  patient  and  recovery. 

This  "  someone  "  is  the  social  worker, — 
a  man  or  woman  trained  to  think  of  a 
human  being  as  a  whole  just  as  naturally 
as  the  physician  concentrates  attention 
upon  a  part. 

''  What's  missing  here  of  the  essentials 
of  a  human  life? ''  asks  the  social  worker. 
No  matter  whether  her  job  is  in  a  factory 
(as  welfare  worker  or  factory  nurse),  in 
an  immigration  station,  in  a  court-room,  in 
an  almshouse,  a  schoolhouse,  or  a  hospital, 
— her  job  is  to  supplement  the  efforts  of 
the  specialist  in  the  interests  of  healthy, 
living  character. 

In  a  hospital-patient  the  missing  neces- 
sities may  be  food  and  clothes,  rest,  work, 
decency,  hope,  self-respect,  a  bath,  a 
crutch,  or  a  confidant; — to  make  him 
wholesome  the  social  worker  looks  stead- 
fastly to  the  man's  whole  needs  and  tries 
to  fill  in  wherever  the  need  is  greatest.    He 


180  SOCIAL  SERVICE  AND 

is  the  synthesizer^  and  he  must  stand  be- 
side the  analyzing  speciahst  always,  if  hos- 
pital work  is  to  be  worth  the  enormous 
sum  it  costs.  The  physician  trained  to 
special  analytic  keenness  can  give  us  diag- 
nosis, but  hospitals  were  not  founded  for 
diagnosis  but  for  diagnosis-issuing-in-effi- 
cient-treatment. 


Ill 

As  I  look  over  the  varieties  of  social 
service  work  which  within  the  past  four 
years  have  been  est  abb  shed  in  a  dozen 
or  more  hospitals  in  Boston,  New  York, 
Chicago,  Philadelpliia,  Baltimore,  and 
Cleveland,  the  degree  of  success  seems  to 
me  to  depend  once  more  on  the  amount  of 
team-work,  that  is,  on  the  intelligent  co- 
operation between  the  social  workers  and 
some  physician  or  physicians  in  the  hos- 
pital itself.  Unless  there  is  at  least  one 
doctor  who  really  knows  what  the  social 


THE  ART  OF  HEALING  181 

worker  is  trying  to  do,  the  scheme  fails. 
If  he  thinks  of  her  merely  as  a  nurse  and 
asks  of  her  only  such  help  as  a  nurse  can 
render,  she  will  either  fall  short  of  his  ex- 
pectations (in  case  she  has  no  adequate 
nurse's  training)  or  will  narrow  herself  to 
fulfill  the  purely  physical  needs  (in  which 
case  she  is  not  doing  social  work) ,  or  finally 
she  will  exceed  his  expectations  and  his 
horizon — ^which  will  make  him  think  her 
"  uppish  "  or  interfering  or  visionary. 

Unless  a  doctor  has  already  acquired 
the  "  social  point  of  view  "  to  the  extent 
of  seeing  that  his  treatment  of  dispensary 
patients  is  slovenly,  without  some  knowl- 
edge of  their  homes,  their  finances,  their 
thoughts  and  worries, — he  will  think  that 
the  social  worker  is  trying  to  teach  him 
how  to  do  his  work  whenever  she  does 
what  he  didn't  and  couldn't  do  before. 
Naturally  he  will  resent  this  indignantly. 
A  doctor  is  treating  a  young  girl — quite 
unsuccessfully — for  insomnia,    A   social 


182  SOCIAL  SERVICE  AND 

worker  discovers  through  a  home  visit  that 
she  is  sleeping  (or  trying  to  sleep)  in  the 
same  bed  Tvdth  two  other  girls, — a  fact  she 
never  would  have  mentioned  to  the  doctor. 
Now,  if  the  doctor  is  quite  unaware  of 
the  social,  financial,  and  psychical  back- 
ground out  of  wliich  individual  "  cases  "  of 
disease  emerge  momentarily  (and  quite 
misleadingly)  at  the  hospital,  he  mil  not 
care  to  be  ad^dsed  by  any  "  woman  charity 
worker."  That  she  can  throw  hght  upon 
"  his  case  "  implies  that  liis  ^dsion  of  it  was 
not  previously  clear.  The  more  useful  she 
is  the  more  it  will  irritate  liim,  if  he  has  not 
pre^^ously  been  led  to  discover  that  he  is 
attempting  a  task  impossible  ^^ithout  some 
such  aid  as  hers.  I  have  seen  a  good  deal 
of  such  irritation  implied  or  expressed  in 
the  comments  of  physicians  on  social  work 
in  hospitals,  and  in  the  long  run  it  is  sure 
to  checkmate  the  effort  of  the  social  worker 
no  matter  how  tactful  she  is. 

It   is   not   worth   while   then,   in   my 


THE  ART  OF  HEALING  183 

opinion,  for  any  outsider  or  outside  body- 
to  establish  social  work  in  a  hospital  unless 
some  physician  in  that  hospital  has  al- 
ready become  aware  of  his  need  of  such 
help.  The  doctor  must  first  have  felt 
the  difficulty  of  finishing  the  work  which 
his  diagnostic  studies  begin  or  of  carry- 
ing into  effect  his  desire  to  go  to  the  bot- 
tom of  his  cases,  to  find  their  cause  (physi- 
cal, chemical,  hygienic,  financial,  domestic, 
emotional,  or  whatever  it  may  turn  out  to 
be)  and  to  root  it  out. 

The  truth  is,  that  before  proper  and 
helpful  co-operation  of  doctor  and  social 
worker  can  be  established  each  of  the  two 
must  educate  the  other  considerably — per- 
haps painfully.  The  social  worker  must  be 
led  to  understand,  for  example,  how  often 
"  laziness  "  is  a  sign  of  disease  rather  than 
of  sin  and  how  devious  and  unexpected  are 
the  paths  by  which  sex-tension  connects 
itself  with  cruelty,  with  "  nervousness," 
and   with   slipshod    habits.     The    doctor 


184  SOCIAL  SERVICE  AND 

must  be  helped  to  see  how  a  patient's 
physical  good  may  have  to  be  sacrificed 
temporarily  in  order  that  a  job  may  not  be 
lost  or  a  family  broken  up. 


IV 

But  this  co-operation  of  doctor  and  social 
worker  is  only  one  of  the  forms  of  team- 
work which  grows  up  in  a  hospital  as  soon 
as  social  work  is  estabhshed  there.  My 
interest  in  its  estabhshment  springs  from 
the  perception  that  it  involves  and  com- 
bines all  the  types  of  team-work  which  this 
book  describes.  It  brings  medical  back- 
grounds and  medical  foregrounds  into 
their  proper  organic  unity.  It  helps  medi- 
cal and  sociological  minds  to  pool  and  ex- 
change their  earnings.  It  allows  the  teach- 
ing art  to  take  its  all-important  part  in 
the  prevention  and  suppression  of  disease. 
Finally  social  workers  can  bring  doctor 
and  patient  still  closer  by  acting  as  inter- 


THE  ART  OF  HEALING  185 

preters,  and  helping  on  a  free,  full,  truth- 
ful explanation  on  both  sides. 

If  I  can  show  how  these  various  teams 
are  actually  hitched  up  when  social  work 
is  established  in  a  hospital,  it  will  serve  to 
focus  and  summarize  the  meaning  of  this 
book. 

(a)  I  have  pictured  in  Chapter  I  that 
insane  separation  of  *  foregrounds  and 
backgrounds  which  hospital  hurry,  medi- 
cal routine,  and  scientific  absent-minded- 
ness tend  to  bring  about.  Now  the  social 
worker  is  not  permeated  by  the  hospital 
traditions  of  hurry;  moreover  she  is  to  a 
certain  extent  defended  from  catching  the 
deadly  miasm  of  routine,  by  the  necessary 
miscellaneousness  of  her  work,  while  the 
very  mainspring  of  her  activity  is  anti- 
specialism.  A  foreground  gone  astray 
from  its  background  shocks  a  social  worker 
hke  a  runaway  horse.  It  must  be  caught 
and  taken  home.  But  the  case-histories 
piled  on  the  desks  in  our  dispensary  cHnics 


186  SOCIAL  SERVICE  AND 

are  just  such  foregrounds  torn  away  from 
their  backgrounds.  No.  3861  describes 
the  shriveled  and  clammy  fingers  of  a 
"  splendid  case  of  Raynaud's  disease  "  and 
how  "  the  case  "  was  engaged  to  return  on 
a  certain  day  for  the  professor's  teaching 
hour,  and  how  the  patient  spontaneously 
improved  each  summer  when  warm 
weather  limbered  her  useless  fingers  till 
the  return  of  winter  renewed  her  suffer- 
ings. All  these  facts  stare  one  in  the  face. 
They  are  in  the  foreground. 

But  the  background, — her  life  away 
from  the  hospital — her  past — ^her  future? 
Where  is  it?  A  social  worker  went  in 
search  of  it,  ascertained  that  the  girl  had 
been  a  good  worker  whenever  her  hands 
were  sound  enough  to  be  of  any  use, 
found  a  place  for  her  as  a  domestic  in 
Florida,  arranged  for  her  journey  thither, 
and  thus  gave  her  a  winter  of  comfort 
and  self-support — her  first  in  many 
years. 


THE  ART  OF  HEALING  187 

(b)  Teaching, — training  has  usually 
gone  hand  in  hand  with  medical  work  in 
our  hospitals, — teaching,  that  is,  for  every- 
one but  the  patients.  Doctors,  students, 
nurses,  ward  tenders,  all  are  getting  their 
training  in  most  of  the  hospitals  of  this 
country.  But  the  patients?  How  many 
of  them  are  being  efficiently  and  skillfully 
taught  those  fundamental  and  far-reach- 
ing lessons  on  which  their  permanent  re- 
covery often  depends  ?  We  know  that  the 
cure  of  most  cases  of  incipient  phthisis,  of 
neurasthenia,  and  dyspepsia  is  made  pos- 
sible only  by  a  long  course  of  training. 
Such  patients  must  learn  to  give  up  Hfe- 
long  habits,  to  acquire  new  ways  of  think- 
ing, new  self-control.  But  they  cannot 
and  will  not  make  these  radical  changes 
in  their  hves  merely  because  they  are 
handed  a  printed  list  of  rules  prescribing 
how  they  shall  eat,  drink,  sleep,  and  act. 
This  problem  the  social  worker  attacks 
as  an  educator — all  the  more  effectively 


188  SOCIAL  SERVICE  AND 

because  she  is  not  merely  an  educator  but 
a  person  endowed  by  the  patient  with  some 
of  the  authority  of  the  hospital  in  which  she 
works,  and  of  the  physicians  with  whom 
she  is  associated.  To  train  a  neurasthenic 
or  a  tuberculous  patient  we  need  the  team- 
work of  doctor,  educator,  and  social 
worker  as  described  in  Chapter  III.  So- 
cial workers  in  hospitals  must  be  or  become 
teachers  and  thus  make  possible  the  triple 
team-work  which  we  need.  This  is  very 
little  reahzed  by  those  who  think  that  an 
ordinary  nurse  or  an  ordinary  associated 
charity  agent,  untrained  for  teaching  and 
unfitted  for  it  by  sympathy  and  interest, 
can  do  social  work  in  hospitals. 

(c)  All  good  team-work  arouses  my 
enthusiasm.  Football,  part  singing,  ma- 
chine poHtics,  even  house-breaking  are 
admirable  so  far  as  team-play  is  manifest 
in  them.  But  of  all  the  forms  of  medical 
team-play  to  which  the  spirit  of  our  time 
is  leading  us,  none  seems  to  me  so  fruitful, 


THE  ART  OF  HEALING  189 

so  full  of  efficiency  and  of  promise,  as 
that  in  which  doctor  and  patient  get  to- 
gether against  their  common  enemy — 
disease. 

This  union  the  social  worker  can  do 
much  to  promote  and  to  develop.  A  pa- 
tient needs  (for  example)  to  be  persuaded 
to  undergo  a  surgical  operation.  The  doc- 
tor has  no  time  to  explain  in  detail  the 
reason  why  he  advises  this  perilous  ven- 
ture. It  is  impossible  for  him  to  blow  his 
own  trumpet  and  expound  his  own  fitness 
to  advise,  his  own  cautious  weighing  of  the 
pros  and  cons.  But  if  the  social  worker 
genuinely  beheves  in  the  physician  with 
whom  she  works,  she  can  speak  for  him  and 
help  to  build  up  in  the  patient  that  well- 
deserved  confidence  which  is  half  the  battle 
in  medical  work. 

Social  workers  may  thus  help  the  patient 
to  have  faith  in  the  expert.  They  also 
help  the  expert  to  have  faith  in  the  patient. 
The  expert  naturally  hesitates  to  explain 


190  SOCIAL  SERVICE  AND 

his  plans  of  treatment  to  the  patient  be- 
cause he  fears  that  the  explanation — ^made 
hastily  in  a  noisy  room  to  a  bewildered  Jew 
or  ItaUan — will  convey  only  that  scrap  of 
knowledge  which  is  a  dangerous  thing. 
So  doctors  have  gone  on  giving  bread  pills 
( encouraging  thereby  the  habit  of  depend- 
ing on  drugs  rather  than  on  hygiene)  be- 
cause there  was  no  time  or  opportunity  ad- 
equately to  explain  to  patients  why  drugs 
are  sometimes  unnecessary,  how  diet,  fresh 
air,  regular  habits,  and  clean  minds  may 
work  both  the  cure  and  the  prevention  of 
disease. 

But  with  the  social  worker  acting  now 
as  teacher  and  interpreter,  passing  on  to 
the  patient  the  doctor's  ideas  in  words  of 
one  syllable,  reiterating  and  illustrating 
them,  following  up  and  correcting  errors 
of  misunderstanding,  it  becomes  possible 
for  the  doctor  to  deal  frankly  and  truth- 
fully with  his  patient,  sharing  knowledge 
rather  than  issuing  arbitrary  commands. 


THE  ART  OF  HEALING  191 

Possessing  at  last  the  principle  of  treat- 
ment, the  patient  can  learn  to  apply  it  to 
himself  and  finally  to  teach  others. 

Can  anything  be  more  inspiring  than 
the  thought  of  the  endless  chain  of  help- 
fulness thus  linked  up  ?  All  over  the  coun- 
try cured  consumptives  are  acting  as  mis- 
sionaries to  teach  other  consumptives  what 
they  must  do  to  be  saved.  But  at  the 
Massachusetts  General  Hospital  this  is 
only  one  of  the  endless  chains  which  our 
team  of  doctor  and  social  worker  con- 
structs. Girls  who  have  been  helped 
through  their  time  of  bitter  trial,  have 
borne  and  cared  for  their  illegitimate  chil- 
dren and  finally  married,  are  now  helping 
to  care  for  other  girls  in  trouble  like  their 
own.  They  in  turn  will  some  day  want  to 
help  others. 

Neurasthenics  who  with  the  help  and 
teaching  of  our  social  workers  have  learned 
to  understand  the  doctor's  ideas,  to  master 
their  vagrant  impulses,  to  "  side-track  " 


192  SOCL\L   SERVICE 

their  nagging  pains,  to  forget  their  fears, 
and  to  get  some  happiness  out  of  Hfe — 


already  some  of  these  "  converted  "  suf- 
ferers are  passing  on  the  gospel  to  others. 
This  is  team-play  extended  to  infinity. 
Without  exaggeration  we  may  say  that 
such  a  linkage  and  brotherhood  of  help- 
fulness has  no  end,  and  that  as  far  and  as 
fast  as  we  can  really  achieve  it  we  spread 
the  kingdom  of  heaven  upon  earth. 


FINIS 


PAUT3 

Cabot 

Social  Service 
And  The  Art  Of  Healing 


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